UNCONTROLLED WHEN PRINTED
Introduction
  • Packed Red Cells type: O negative
  • Packed red blood cells replace lost haemoglobin with the intent of improving O2 carrying capacity of the circulation

"Treatment of haemorrhagic shock involves maintaining blood pressure and tissue perfusion until the bleeding is controlled" (Kwan, I. et al., The Cochrane Library, 2000)

Indications
  • Patients symptomatic of reduced oxygen-carrying capacity secondary to exsanguination.
Contraindications
  • Once blood is opened or “spiked”, the blood components will expire 4 hours after opening and must be infused in this time
  • Presence of medical directive / advanced directive / alert card expressing that they refuse blood under any circumstances (e.g.: Jehovah’s Witnesses or non-consenting patient)
  • A temperature rise to >38°C should result in immediate cessation of the transfusion
  • Exercise caution in hypothermic patient with rise >1°C who have commenced active warming
Precautions / Notes
  • Routine warming of blood is not necessary.
  • Severe reactions are uncommon, however they are most likely to occur within the first 15 minutes/50mls of each unit and patients should be closely observed during this period especially for signs of fever and loin pain or discomfort.
  • Blood transfusion should never be a substitute for meticulous haemorrhage control.
  • No medications or solutions (except 0.9% sodium chloride solution) should be added to the blood bag or co-administered through the same giving set.
  • As a minimum; the vital signs of temperature, pulse, respiration rate and blood pressure prior to commencing infusion and every 15 minutes thereafter.
Management
Critical Care Paramedic only
Paediatric Patients
  • For patients <12yrs: First obtain ASMA approval. Administer 10ml/kg, maximum 1 unit.
  • If bleeding is the obvious cause, is not fully controlled and there is evidence of inadequate organ perfusion: administer blood as first line agent, as crystalloid solution will only further dilute the clotting factors and platelets.
  • If the cause of loss of consciousness / hypotension / tachycardia is unclear, then administering IV fluids as first line agent may be more appropriate.
  • Once dose achieved, leave Packed Red Cells in situ if less than 3 hours from use.
  • Check external blood box thermometer reading within range of 2.5 - 6°C. If not: do not use.
  • Check internal data logger ensure temp within 2.5 - 6°C. If not: do not use.
  • Check blood product details (ensure O negative)
  • Check expiry date and time of blood
  • All attempts should be made to maintain patient momentum to definitive care
  • Obtain verbal consent from patient where possible including discussion of proposed red cell transfusion risks and benefits of transfusion, including risks of doing nothing. Document verbal consent in ePCR
  • Check that the integrity of the blood product is confirmed. No leaks at ports / packing seams, no evidence of haemolysis (unusual discolouration or turbidity), or large clots.  If identified / if in doubt: do not transfuse.
  • Ensure large bore IV access; take blood for laboratory (pink vial).
  • Transfuse through filtered IV giving set approved for blood administration (170-20um Filter) to remove clots and aggregates. Ensure primed with normal saline.
  • If required, transfuse through the MEQU Fluid & Blood Warmer.
  • Ascertain base line observations and document accordingly.
  • Monitor patient for adverse effects.
  • If any concerns arise from transfusion reaction:
    • Cease transfusion and manage appropriately.
    • Report all transfusion reactions to receiving medical team and ASMA post case.
    • Document in ePCR.
    • Should a transfusion reaction have taken place, keep the blood bag and handover to medical team.
  • Incomplete transfusion bags to be left with medical staff / nursing staff at receiving hospital.
  • Unused units to remain in Pelican case and returned to HEM base if temp remains within range 2.5 - 6°C
  • Complete blood issuing paperwork.
Special Considerations
  • Febrile (non-haemolytic) transfusion reaction.
  • Acute and delayed haemolytic reaction.
  • Allergy / Anaphylaxis.
  • Transfusion-related circulatory overload (TACO).

References
References
Presentation
Approx. 260ml - 300ml bag for intravenous administration
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