Blood Transfusion Key Principles

Australia has one of the safest blood supplies in the world. However, the transfusion of blood and blood products is not without risk and can lead to complications and adverse outcomes for patients. Blood and blood products should only be given when clearly indicated and expected benefits to the patient outweigh the potential hazards.

Standard 7 of the National Safety and Quality Healthcare Standards mandates how hospitals and clinicians should manage blood and blood product transfusion. The four criterion that must be met cover:

Governance and systems for blood and blood product prescribing and clinical use
Documenting patient information
Managing blood and blood product safety
Communicating with patients and carers.

The following information and links will assist the HMO in managing blood and blood product transfusions.

Check up to date Governance Documentation for Blood and Blood Product Transfusions on the BHS intranet

Zero Tolerance

Know the requirements for taking a pre-transfusion blood sample. Samples that do not meet requirements shall be discarded by the laboratory and a repeat sample requested.

Blood Bank Samples

Group and Hold vs Cross Match

Request either a Group and Hold Serum or Crossmatch , but not both.
Group and Hold is the first part of a crossmatch, where blood group and antibody screen is done.
Only order units to be crossmatched if you intend to transfuse.

Fresh Frozen Plasma (FFP)

FFP will be issued on request, but please ensure you intend to transfuse. FFP that is thawed and not transfused is often discarded, leading to high wastage rates.
If Prothrombinex is available, FFP is not required for Warfarin reversal. Refer to An update of consensus guidelines for warfarin reversal
2 units of FFP will be thawed on activation of the Massive Transfusion Protocol (BHS intranet only)

Prescription and Consent

All blood and blood product transfusions must be prescribed on the Blood Orders Form MR683.0
A patient’s transfusion history must be documented on the Blood Orders Form MR683.0
Unless an emergency situation, signed consent must be obtained prior to transfusion using the Blood Transfusion Consent Form MR360.03
A patient information leaflet is attached to the consent form and should be given to the patient at the time of consent.
Platelets should be ordered as 1 bag (contains an adult dose of platelets that should increase the platelet count by 20,000 – 40,000).

Single Unit Transfusion

The aim of transfusion is to relieve symptoms of anaemia and replace blood volume in the trauma patient. Every bag of blood has the potential to cause harm, so restrictive transfusion practice can be applied in most situations.
The practice of single unit transfusion can be applied to stable, normovolaemic adult patients, in an inpatient setting, who do not have clinically significant bleeding.
Each unit transfused should be an independent clinical decision

Managing Transfusion Reactions

Patient Blood Management Guidelines (NH&MRC)

Access online here

Module 1 – Critical Bleeding / Massive Transfusion
Module 2 – Perioperative
Module 3 – Medical
Module 4 – Critical Care
Module 5 – Obstetrics and Maternity
Module 6 – Paediatrics / Neonates

BHS Education Resource