Administration of Blood Products Containing Red Cells

All blood products should be warmed gently to room temperature if time allows. If preferred, products can be warmed to body temperature (37°C) using a warm water bath. Water must be monitored using a thermometer as it must not go above 37°C. Alternatively, you can use a commercial water bath. The product should be protected in a plastic zip lock bag to prevent contamination of the ports.

Products containing red cells should be given through a filter to facilitate removal of any small clots and other debris that may be present. These filters may be an integral part of the blood administration sets or attached to the extension line (Hemo-nate filters - available from PBB) if delivering the red cell transfusion from a syringe via an intravenous extension set (common with cats and small dogs). Peristaltic type infusion pumps are not recommended for the administration of red cell containing products unless the manufacturer has specifically stated they are safe to do so. We recommend a new administration set or filter and extension set is used for each new unit of red cells.

With stable patients, an initial infusion rate of 0.5-1.0 ml/kg/hr should be used for the first 15-30 minutes. During this time the patient should be monitored for any evidence of a transfusion reaction. If no reaction is seen this can be increased to a standard rate of 5-10ml/kg/hr. Any red cells remaining in the bag or syringe 4 hours after breach or withdrawal into a syringe (and remaining at room temperature) must be discarded. Blood units can be separated into smaller volumes if the time over which they are to be given will exceed 4 hours (see Blood Component Unit Separation Guide). In an emergency (e.g. severe acute haemorrhage), red cells can be given at up to shock rates. Slower rates of 1-2ml/kg/hr are recommended for patients with circulatory compromise.

In the past, packed red blood cells required re-suspension with 0.9% NaCl as their PCV was so high that they could not be infused alone. However, as packed red cell products today typically have had a red cell extender (nutrient solution) added, this is less of a problem and resuspension with saline is rarely necessary. Calcium containing fluids such as Hartmann’s solution must NEVER be used with blood products.

A number of calculations have been suggested to evaluate the amount of red cells needed:

These equations should be used as a guide only – when considering how much blood to obtain or administer. Considering at this time that we are often limited in the amount of blood available and that patients often have ongoing losses/concurrent fluid issues that are not accounted for in these equations, they are rarely of practical use except in very small patients where it is possible to raise the PCV too much if a full unit of blood is given – or in very large and very compromised patients where to make a significant difference multiple units of product may need to be administered.

Blood typing prior to administration should be standard procedure and cross matching will be required if a transfusion has been given more than 4 days previously.

Administration of Plasma Products

Prior to administration, all blood products should be warmed to room temperature if time allows. If preferred, products can be warmed to body temperature (37 °C) using a warm water bath (ensure that water is monitored at not more than 37°C using a thermometer, or use a commercial water bath). The product should be protected in a plastic zip lock bag to prevent contamination of the ports.

Plasma products must be handled with care as they are very brittle whilst frozen and thawed slowly. Plasma products should be given through a filter to facilitate the removal of any debris that may be present. These filters may be an integral part of the blood administration sets or attached to the extension line (Hemo-nate filters - available from PBB) if delivering the plasma transfusion from a syringe via an intravenous extension set (common with cats and small dogs). Peristaltic type infusion pumps may be used. Please check the suitability of the pump for blood administration and the compatibility/ accuracy of the giving set with the manufacturer prior to use. We recommend a new administration set or filter and extension set is used for each new unit of plasma.

An initial infusion rate of 0.5-1.0 ml/kg/hr should be used for the first 15-30 minutes. During this time the patient should be monitored for any evidence of a transfusion reaction. If no reaction is seen this can be increased to a standard rate of 5-10ml/kg/hr. Slower rates of 1-2ml/kg/hr are recommended for patients with circulatory compromise. Any plasma remaining in the bag or syringe 4 hours after breach or withdrawal into a syringe (and remaining at room temperature) must be discarded. Plasma units can be separated into smaller volumes if the time over which they are to be given will exceed 4 hours (see Blood Component Unit Separation Guide).

The standard recommended dose of FFP, FP or Cryo-S for management of coagulopathies is 10-30ml/kg. The patient’s coagulation should be closely monitored as the required dose may be more or less than the standard dose. To manage hypoalbuminaemia, the recommended dose is 30ml/kg given as a continuous rate infusion. Higher rates are typically associated with greater increases in albumin. Patients should be monitored closely for signs of over infusion.

The recommended dose for Cryo-P to manage coagulopathies is 1 unit per 10kg bodyweight. An initial infusion rate of 0.5-1.0 ml/kg/hr should be used for the first 15-30 minutes. During this time the patient should be monitored for any evidence of a transfusion reaction. If no reaction is seen this can be increased to a standard rate of 5-10ml/kg/hr. Slower rates of 1-2ml/kg/hr are recommended for patients with circulatory compromise. Any Cryo-P remaining in the bag or syringe 4 hours after breach or withdrawal into a syringe (and remaining at room temperature) must be discarded. Cryo units can be separated into smaller volumes if the time over which they are to be given will exceed 4 hours (see Blood Component Unit Separation Guide).

Blood typing prior to administration should be standard procedure as red cells are required at a later date. Cross matching is not required prior to plasma administration unless dogs have received multiple plasma transfusions in the past and reactions have been recorded.