Blood products

The "limited donor exposure programme" (LDEP) was implemented in order to decrease donor exposure for those neonates/ paediatrics who are on long-term transfusion therapy. The advantages of the LDEP/ infant red cell concentrates are as follows: (1) the complete dose is derived from a single donor; (2) reduced donor exposure for the patient; (3) reduced risk of alloimmunisation to HLA antigens. Neonatal units should arrange with the Blood Bank that those neonates with extended transfusion needs are placed on LDEP. Two to four units of infant red cell concentrates are reserved for one patient. The infant red cell concentrate is derived from a single unit of adult red cell concentrate that is divided into 4 individual units.

The infant red cell concentrate is produced from a single unit of red blood cells that has been leucocyte filtered then equally divided between 4 transfer bags. Each individual unit has a haematocrit of 0.5 l/l – 0.7 l/l and a volume of 55 ml ± 20 ml.

Benefits of the Limited Donor Exposure Programme LDEP

• Reduced donor exposure for the patient
• Reduced risk of alloimmunisation to red blood cell antigens
• Reduced risk of transfusion transmitted infection
• Reduced product wastage  

How does LDEP work?
The clinician should indicate on the cross-match request form that they wish to place the infant on the Programme by writing “LDEP” and the number of units to be reserved. A minimum of 2 and maximum of 4 units may be selected. If this has not been indicated then 2 units will be kept. For private patients, the units will be reserved until expiry. The patient will be billed irrespective of whether the units were used or not.  
 
Eligibility for LDEP
Low birth weight neonates (< 1500 g) who require frequent transfusions due to various conditions can be placed on LDEP.

Should units be gamma-irradiated?
Although blood components given to mature infants are not irradiated routinely, irradiation is advised for all components to be transfused either to infants in utero or to newborn infants of birthweight less than 1200 g (Strauss et.al 1990)

Gamma-irradiated blood and blood products are provided upon request. The irradiation procedure is performed at our blood bank which is situated at the Red Cross War Memorial Children’s Hospital. The irradiated blood and blood products are then transported to the requesting blood bank, for issue to the ward.

Gamma-irradiation is currently the only recommended method for the prevention of TA-GVHD. When indicated gamma-irradiated blood and blood products should be administered to all blood products containing significant numbers of white cells. Blood may be irradiated at any time up to 14 days after collection and thereafter stored for a further 14 days after irradiation. Where there is a particular risk of hyperkalaemia (IUT, ET), it is recommended that red cells (usually whole blood in these cases) be transfused within 24 hours of irradiation.

Should units for infants be gamma-irradiated?
Although blood components given to mature infants are not irradiated routinely, irradiation is advised for all components to be transfused either to infants in utero or to newborn infants of birthweight less than 1200 g (Strauss et.al 1990)

Plasma products are rich in clotting factors. It is separated from whole blood donations, by component separation techniques.

Fresh Frozen Plasma

A unit of fresh frozen plasma is produced by separating the plasma from a unit of whole blood, within 18 hours of collection, then freezing at ≤ minus 23 ºC.
Volume: 280 ± 70 ml
Anticoagulant: CPD
Storage temperature: Minus 18 ºC to minus 23 ºC or lower, for 1 year.
Shelf life: 6 hours from time of removal from storage.
Composition: Fibrinogen 200 mg per unit of FFP, FII 1.03 IU/ml, FV 0.64 IU/ml, FVII 1.21 IU/ml, FVIII 0.85 IU/ml, FIX 0.95 IU/ml, FX 1.25 IU/ml, FXI 0.79 IU/ml, Antithrombin III 104 IU/ml, Plasma pseudo-cholinesterase 3000-10 000 IU/L. Solutes: Glucose 24.8 mmol/l, Sodium 165mmol/l, Osmolarity 322 mmol/l, Potassium 3.0 mmol/l, Chloride 79 mmol/l and pH 7.3.
Indications: Replacement of inherited single factor defciencies, multiple coagulation factor deficiencies, thrombotic thrombocytopenic purpura (TTP), reversal of Warfarin effect, Vitamin K defciency, Scoline Apnoea.
Not indicated for: Hypovolaemia, plasma exchange procedure (except TTP), nutritional support and protein losing states.
Special precautions: ABO compatibility preferred. Do not add any fluids or drugs. FFP is hyperosmolar due to the solutes listed, care should be taken not to precipitate pulmonary oedema if cardiopulmonary function is compromised and tissue oedema is present. Hypernatraemia and hypokalaemia may occur if large volumes are transfused.
Rate of infusion: Administer through a standard blood administration set within 15-20 minutes. Further therapy is dependent on clinical response and laboratory monitoring.

Leucocyte Reduced Fresh Frozen Plasma

A unit of leucocyte reduced fresh frozen plasma is produced by leucocyte filtering a unit of fresh frozen plasma, after it has been thawed.
Volume: 280 ± 70 ml
Anticoagulant: CPD
Storage temperature: Minus 18 ºC to minus 23 ºC or lower, for 1 year
Shelf life: 6 hours from time of removal from storage
Composition: Fibrinogen 200mg per unit of FFP, FII 1.03 IU/ml, FV 0.64 IU/ml, FVII 1.21 IU/ml, FVIII 0.85 IU/ml, FIX 0.95 IU/ml, FX 1.25 IU/ml, FXI 0.79 IU/ml, Antithrombin III 104 IU/ml, Plasma pseudo-cholinesterase 3000-10 000 IU/L. Solutes: Glucose 24.8 mmol/l, sodium 165 mmol/l, Osmolarity 322 mmol/l, Potassium 3.0 mmol/l, Chloride 79 mmol/l and pH 7.3
Indications: Replacement of inherited single factor deficiencies, multiple coagulation factor deficiencies, thrombotic thrombocytopenic purpura (TTP), reversal of Warfarin effect, Vitamin K defciency, Scoline Apnoea.
Not indicated for: Hypovolaemia, plasma exchange procedure (except TTP), nutritional support and protein losing states.
Special precautions: ABO compatibility preferred. Do not add any fluids or drugs. FFP is hyperosmolar due to the solutes listed, care should be taken not to precipitate pulmonary oedema if cardiopulmonary function is compromised and tissue oedema is present. Hypernatraemia and hypokalaemia may occur if large volumes are transfused.
Rate of infusion: Administer through a standard blood administration set within 15-20 minutes. Further therapy is dependent on clinical response and laboratory monitoring.

Fresh Frozen Plasma Cryo Poor (Cryosupernatant)

A unit of cryoprecipitate poor fresh frozen plasma (cryosupernatant) is produced by removing the cryoprecipitate from a unit of fresh frozen plasma, before freezing.
Volume: 250 ± 60 ml
Anticoagulant: CPD
Storage temperature: Minus 18 ºC to minus 23 ºC or lower, for 1 year
Shelf life: 6 hours from time of removal from storage
Composition: Contains vitamin K dependant coagulation factors similar to fresh frozen plasma since vitamin K impacts on FII, FVII, FIX, FX, prothrombin, protein C and protein S.
Indications: Used for the treatment (with or without plasma exchange) of thrombotic thrombocytopenic purpura (TTP).
Special precautions: Do not add any fluids or drugs.
Rate of infusion: Administer through a standard blood recipient set within 15-20 minutes.

Cryoprecipitate

A unit of cryoprecipitate is produced by extracting the cold insoluble fraction of fresh frozen plasma which remains after the thawing and draining at 0 ºC to 4 ºC, within 8 hours of collection.
Volume: 10 ± 1 ml
Anticoagulant: CPD
Storage temperature: Minus 18 ºC to minus 23 ºC or lower, for 1 year
Shelf life: 4 hours from time of removal from storage
Composition: FVIII/vWF ±100 IU per unit, fibrinogen 150-250 mg per unit, fibronectin, FXIII
Indications: Hypofbrinoginaemia, Factor XIII deficiency, in emergency situations in Haemophilia A if Factor VIII is not available.
Not indicated for: Deficit of other coagulation factors or hypovolaemia.
Special precautions: Do not add any fluids or drugs. Cryoprecipitate does not have a pathogen reduction process whereas freeze-dried Anti-Haemophilic Factor does.
Rate of infusion: Administer through a standard blood recipient set within 15 minutes.

There are essentially two types of platelet products i.e. platelets that are harvested by apheresis technique and platelets that are derived from individual random whole blood donations that are pooled into one bag.

Apheresis Single Donor Platelet

A unit of single donor platelets is produced by harvesting the platelets from a single donor, by apheresis technique. The advantages of single donor apheresis platelets are as follows. (1) The complete dose is derived from a single donor; (2) reduced donor exposure for the patient; (3) reduced risk of alloimmunisation to HLA antigens; (4) product is integrally leucocyte depleted; (5) minimal product intervention is required.
Volume: 275 ± 75 ml
Platelet yield: > 2.4 x 1011/l
Anticoagulant: ACD-A
Storage temperature: 20 ºC to 24 ºC
Shelf life: 5 days
Indications: Patients requiring long term platelet support eg. leukaemia; febrile reactions due to sensitistion to leucocyte antigens, bleeding associated with thrombocytopenia, defective platelet function, bone marrow failure, massive transfusion with dilutional thrombocytopenia, acute disseminated intravascular coagulation, congenital disorders of platelet function.
Not indicated for: Immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), heparin induced thrombocytopenia (HIT).
Special precautions: ABO compatibility preferred. Do not add any fluids or drugs.
Rate of infusion: Administer through a platelet giving set within 15-30 minutes.

Pooled Random Donor Platelet

A unit of pooled random donor platelets is produced by pooling the buffy coats from individual random whole blood donations and the plasma from one of the donations in the pool, into one bag.
Volume: > 200 ml
Platelet yield: > 2.4 x 1011/l
Anticoagulant: CPD
Storage temperature: 20 ºC to 24 ºC
Shelf life: 5 days
Indications: Bleeding associated with thrombocytopenia, defective platelet function, bone marrow failure, massive transfusion with dilutional thrombocytopenia, acute disseminated intravascular coagulation, congenital disorders of platelet function.
Not indicated for: Immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), heparin induced thrombocytopenia (HIT).
Special precautions: Do not add any fluids or drugs.
Rate of infusion: Administer through a platelet giving set within 15-30 minutes

Pooled Random Donor Platelet Leucocyte Depleted

A unit of leucocyte depleted pooled random platelets is produced by leucocyte filtering a unit of pooled random donor platelets.  
Volume: 250 ± 50 ml
Platelet yield: >2.4 x 1011/l
Anticoagulant: CPD
Storage temperature: 20 ºC to 24 ºC
Shelf life: 24 hours
Indications: Recurrent febrile non-haemolytic transfusion reactions, bleeding associated with thrombocytopenia, defective platelet function, bone marrow failure, massive transfusion with dilutional thrombocytopenia, acute disseminated intravascular coagulation, congenital disorders of platelet function.
Not indicated for: Immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), heparin induced thrombocytopenia (HIT).
Special precautions: Do not add any fluids or drugs.
Rate of infusion: Administer through a platelet giving set within 15-30 minutes.

All of our infant/paediatric blood and blood products are leucocyte depleted. The advantage of leucocyte depletion is that it decreases the risk of alloimmunisation to HLA antigens.

Paediatric Whole Blood Leucocyte depleted

A unit of leucocyte depleted paediatric whole blood is produced by leucocyte filtering a unit of whole blood that is less than 48 hours old, then equally dividing it into 3 packs.
Volume: 170 ± 30 ml
Anticoagulant: CPD
Storage temperature: 2 °C to 6 °C
Shelf life: 24 hours
Indications: Recurrent febrile non-haemolytic transfusion reactions, exchange transfusion in neonates.
Not indicated for: Conditions responsive to specific components.
Special precautions: Compatibility testing must be performed. Do not add any fluids or drugs. Clotting factor and platelet function deteriorate rapidly with storage.
Comments: Where there is a particular risk from hyperkalaemia (intra-uterine transfusion, exchange transfusion), it is recommended that red cells (usually whole blood in these cases) be transfused within 24 hours of irradiation.
Rate of infusion: Administer through a standard blood recipient set.

All of our infant/paediatric blood and blood products are leucocyte depleted. The advantage of leucocyte depletion is that it decreases the risk of alloimmunisation to HLA antigens.

Paediatric Single Donor Apheresis Platelet

A unit of paediatric single donor apheresis platelets is produced by splitting an adult single donor apheresis platelet, into 2 packs, dependent on the platelet yield and volume of the original product. These platelets are leucocyte depleted.
Volume: 150 ± 50 ml
Platelet yield: ≥ 1.0 to 2.3 X 1011/l
Anticoagulant: ACD - A
Storage temperature: 20 °C to 24 °C
Shelf life: 5 days
Indications: Recurrent febrile non-haemolytic transfusion reactions, thrombocytopenia, aplastic anaemia.
Not indicated for: Immune thrombocytopenic purpura (ITP), Thrombotic thrombocytopenic purpura (TTP), Heparin induced thrombocytopenia (HIT).
Special precautions: ABO group specifc platelets are recommended. In neonatal allo-immune thrombocytopenia, HPA-compatible platelets are required. In an emergency, use of maternal platelets is an option when the count is <30 x 109 /l. Platelets transfused in utero to treat alloimmune thrombocytopenia and platelet transfusions given after birth to infants who have received either red cells or platelets in utero should be irradiated.
Rate of infusion: Recommended dosage in neonates is 5-10ml/kg. Transfuse within 15-30 minutes.

Infant Single Donor Apheresis Platelet

A unit of infant single donor apheresis platelets is produced by splitting an adult single donor apheresis platelet into 4 packs, dependent on the platelet yield and volume of the original product. These platelets are leucocyte depleted. 
Volume: 60 ± 20 ml
Platelet yield: ≥ 0.5 x 1011/l
Anticoagulant: ACD-A
Storage temperature: 20 °C to 24 °C
Shelf life: 5 days
Indications: Recurrent febrile reactions due to sensitistion to leucocyte antigens, thrombocytopenia, aplastic anaemia.
Not indicated for: Immune thrombocytopenic purpura (ITP), Thrombotic thrombocytopenic purpura (TTP), Heparin induced thrombocytopenia (HIT).
Special precautions: ABO group specifc platelets are recommended. In neonatal allo-immune thrombocytopenia, HPA-compatible platelets are required. In an emergency, use of maternal platelets is an option when the count is <30 x 109 /l. Platelets transfused in utero to treat alloimmune thrombocytopenia and platelet transfusions given after birth to infants who have received either red cells or platelets in utero should be irradiated.
Rate of infusion: A dose of 5 - 10ml/kg is recommended. Transfuse within 15 - 30 minutes.

All of our infant/paediatric blood and blood products are leucocyte depleted. The advantage of leucocyte reduction is that it decreases the risk of alloimmunisation to HLA antigens.

Infant Red Cell Concentrate Leucocyte Depleted

A unit of leucocyte depleted infant red cell concentrate is produced by leucocyte filtering a unit of red cell concentrate that is less than 48 hours old, then equally dividing it into 4 packs.
Volume: 65 ± 20 ml
Haematocrit: 0.5 - 0.7 l/l
Anticoagulant: CPD
Additive solution: SAGM
Storage temperature: 2 °C to 6 °C
Shelf life: 42 days
Indications: Recurrent febrile non-haemolytic transfusion reactions, anaemia, acute blood loss, intra-uterine transfusion, exchange transfusion.
Not indicated for: Pharmacologically treated anaemia.
Special precautions: Compatibility testing must be performed. Do not add any fluids or drugs. Potassium levels increase rapidly with storage. 2.3DPG levels deteriorate rapidly with storage.
Comments: Where there is a particular risk of hyperkalaemia (IUT, ET), it is recommended that red cells (usually whole blood in these cases) be transfused within 24 hours of irradiation.
Rate of infusion: Administer through a standard blood recipient set within 5 hours depending on patient tolerance. Do not exceed 5ml/kg/h for top-up transfusion.

Paediatric Red Cell Concentrate Leucocyte depleted

A unit of leucocyte depleted paediatric red cell concentrate is produced by leucocyte filtering a unit of red cell concentrate that is less than 48 hours old, then equally dividing it into 2 packs.
Volume: 120 ± 30 ml
Haematocrit: 0.5 - 0.7 l/l
Anticoagulant: CPD
Additive solution: SAGM
Storage temperature: 2 °C to 6 °C
Shelf life: 42 days
Indications: Recurrent febrile non-haemolytic transfusion reactions, anaemia, acute blood loss, intra-uterine transfusion, exchange transfusion.
Not indicated for: Pharmacologically treated anaemia.
Special precautions: Compatibility testing must be performed. Do not add any fluids or drugs. Potassium levels increase rapidly with storage. 2.3DPG levels deteriorate rapidly with storage.
Comments: Where there is a particular risk from hyperkalaemia (IUT, ET), it is recommended that red cells (usually whole blood in these cases) be transfused within 24 hours of irradiation.
Rate of infusion: Administer through a standard blood recipient set within 5 hours depending on patient tolerance. Do not exceed 5ml/kg/h for top-up transfusion.

All of our infant/paediatric blood and blood products are leucocyte depleted. The advantage of leucocyte depletion is that it decreases the risk of alloimmunisation to HLA antigens.

Paediatric Fresh Frozen Plasma

A unit of paediatric fresh frozen plasma is produced by dividing a unit of adult fresh frozen plasma, before freezing, into 2 smaller packs.
Volume: 130 ± 30 ml
Anticoagulant: CPD
Storage temperature: Minus 18 °C to minus 23 °C or lower, for 1 year.
Shelf life: 6 hours from time of removal from storage.
Indications: Haemorrhage Disease of the Newborn, neonates with coagulopathy, invasive procedure.
Contra-indications: There is no justification for use of FFP in hypovolaemia, plasma exchange procedure (except TTP), nutritional support and protein losing states.
Special precautions: ABO compatibility preferred. For Haemorrhage Disease of the Newborn use FFP and Vitamin K intravenously.
Comments: FFP contains physiological levels of all clotting factors.
Rate of infusion: Administer through a standard blood recipient set. A dose of 10- 20ml/kg is recommended. Further therapy is dependent on clinical response and laboratory monitoring.

Leucocyte Depleted Paediatric Fresh Frozen Plasma

A unit of leucocyte depleted paediatric fresh frozen plasma is produced by leucocyte filtering a unit of paediatric fresh frozen plasma, before freezing.  
Volume: 130 ± 30 ml
Anticoagulant: CPD
Storage temperature: Minus 18 °C to minus 23 °C or lower, for 1 year.
Shelf life: 6 hours from time of removal from storage.
Indications: Recurrent febrile non-haemolytic transfusion reactions, Haemorrhage Disease of the Newborn, neonates with coagulopathy, invasive procedure.
Contra-indications: There is no justification for use of FFP in hypovolaemia, plasma exchange procedure (except TTP), nutritional support and protein losing states.
Special precautions: ABO compatibility preferred. Infants <1 year old and children on chronic regimens should receive leucocyte depleted products. For Haemorrhage Disease of the Newborn use FFP and intravenous Vitamin K.
Comments: FFP contains physiological levels of all clotting factors.
Rate of infusion: Administer through a standard blood recipient set. A dose of 10-20ml/kg is recommended. Further therapy is dependent on clinical response and laboratory monitoring.

Fresh Frozen Plasma Low Titre Anti-T

A unit of low titre Anti-T fresh frozen plasma is produced by selecting a unit of group AB fresh frozen plasma that has been tested and found to be low titre for Anti-T.
Volume: 280 ± 70 ml
Anticoagulant: CPD
Storage temperature: Minus 18 °C to minus 23 °C or lower, for 1 year.
Shelf life: 6 hours from time of removal from storage.
Indications: For the treatment of neonates who is Crypt antigen positive.
Comments: FFP contains physiological levels of all clotting factors.
Rate of infusion: Administer through a standard blood recipient set. A dose of 10-20ml/kg is recommended. Further therapy is dependent on clinical response and laboratory monitoring.

Cryoprecipitate Low Titre Anti-T

A unit of low titre Anti-T cryoprecipitate is produced by selecting a unit of group AB crypoprecipitate that has been tested and found to be low titre for Anti-T.
Volume: 10 ± 1 ml
Anticoagulant: CPD
Storage temperature: Minus 18 °C to minus 23 °C or lower, for 1 year.
Shelf life: 4 hours from time of removal from storage.
Composition: Contains Factor VIII/vWF ±100 IU per unit, fibrinogen 150 - 200mg per unit, fibronectin, Factor XIII.
Indications: For the treatment of neonates who is Crypt antigen positive.
Rate of infusion: Administer through a standard blood recipient set within 15 minutes.

Whole blood is a complex tissue that contains all of the blood components. These components, particularly the platelet function and coagulation factors deteriorate rapidly with storage. 

Whole Blood

A unit of whole blood is produced from a whole blood donation that does not undergo any processing steps.  
Volume: 513 ± 45 ml
Anticoagulant: CPD
Storage temperature: 2 °C to 6 °C
Shelf life: 35 days
Indications: Anaemia, severe haemorrhage, volume replacement, exchange transfusion in neonates.
Not indicated for: Conditions responsive to specifc components.
Special precautions: Compatibility testing must be performed; do not add any fluids or drugs; calcium containing fluids should not be used with citrated whole blood. Clotting factor and platelet function deteriorate rapidly with storage.
Rate of infusion: Administer through a standard blood recipient set. Infuse as fast as the patient can tolerate for severe blood loss.

Whole Blood Leucocyte Depleted

A unit of leucocyte depleted whole blood is produced by leucocyte filtering the freshest unit of whole blood that is available in the Blood Bank.
Volume: 475 ± 50 ml
Anticoagulant: CPD
Storage temperature: 2 °C to 6 °C
Shelf life: 24 hours
Indications: Recurrent febrile non-haemolytic transfusion reactions, anaemia, severe haemorrhage, volume replacement, exchange transfusion in neonates.
Not indicated for: Conditions responsive to specific components.
Special precautions: Compatibility testing must be performed; do not add any fluids or drugs; calcium containing fluids should not be used with citrated whole blood. Clotting factor and platelet function deteriorate rapidly with storage.
Rate of infusion: Administer through a standard blood recipient set. Infuse as fast as the patient can tolerate for severe blood loss.

Red cell components are useful for its iron-rich stores. It is indicated for a wide range of medical and surgical conditions for treating surgical and medical anaemia.

Red Cell Concentrate    

A unit of red cell concentrate is produced by removing the plasma and buffy coat from a unit of whole blood.  
Volume: 300 ± 50 ml
Haematocrit: 0.5 - 0.7 l/l
Anticoagulant: CPD
Additive solution: SAGM
Storage temperature: 2 °C to 6 °C
Shelf life: 42 days
Indications: Acute blood loss, general surgery, anaemia in Acute Coronary Syndromes (ACS), anaemia, cardiac surgery, obstetric haemorrhage.
Not indicated for: Pharmacologically treated anaemia.
Special precautions: Compatibility testing must be performed. Do not add any fluids or drugs.
Rate of infusion: Administer through a standard blood recipient set. For adults administer within 6 hours depending on patient tolerance.

Red Cell Concentrate Pre-Storage Leucocyte Depleted

A unit of pre-storage leucocyte depleted red cell concentrate is produced by leucocyte filtering a unit of red cell concentrate, within 48 hours of collection. 
Volume: 260 ± 50 ml
Haematocrit: 0.5 - 0.7 l/l
Anticoagulant: CPD
Additive solution: SAGM
Storage temperature: 2 °C to 6 °C
Shelf life: 42 days
Indications: Recurrent febrile non-haemolytic transfusion reactions, patients on chronic transfusion regimens, patients at risk for CMV infection, organ and stem cell transplant patients, critically ill patients, patients undergoing cardiac surgery.
Not indicated for: Pharmacologically treated anaemia.
Special precautions: Compatibility testing must be performed. Do not add any fluids or drugs.
Rate of infusion: Administer through a standard blood recipient set. Adults within 6 hours.

Red Cell Concentrate Leucocyte Depleted

A unit of leucocyte depleted red cell concentrate is produced by leucocyte filtering the freshest unit of red cell concentrate that is available in the Blood Bank.
Volume: 260 ± 50 ml
Haematocrit: 0.5 - 0.7 l/l
Anticoagulant: CPD
Additive solution: SAGM
Storage temperature: 2 °C to 6 °C
Shelf life: 24 hours
Indications: Recurrent febrile non-haemolytic transfusion reactions, patients on chronic transfusion regimens, patients at risk for CMV infection, organ and stem cell transplant patients, critically ill patients, patients undergoing cardiac surgery.
Not indicated for: Pharmacologically treated anaemia
Special precautions: Compatibility testing must be performed. Do not add any fluids or drugs.
Rate of infusion: Administer through a standard blood recipient set. Infuse adults within 6 hours.

We have 97 emergency blood banks, situated throughout the Western Cape Region of South Africa, thereby ensuring the availability of Group O blood, when there is no time to wait for blood to be cross-matched. The emergency banks are situated in hospitals that do not have a Blood Bank on site and at some Blood Banks, keeping emergency blood.

Ideally, not more than 4 units of group O emergency blood should be infused per patient, at one time. If the doctor anticipates that more than 4 units will be required, he/she must submit the patient sample as soon as possible for cross-matching and if possible, when the patient is in an outlying hospital to get him/her to a centre where there is more ready access to a staffed blood bank. This will prevent unnecessary wastage of Group O emergency blood.

The stock is replaced approximately every 3 weeks, to ensure that only the freshest blood is available. Replacement stock should be ordered from the closest Blood Bank as soon as possible, to ensure that there is always blood available. The blood is stored in a bar-type fridge that is supplied and maintained by us.

Unused emergency blood may be accepted back into stock, if it adheres to the emergency blood usage protocol. That is, all emergency blood units in emergency fridges are affixed to a ring with a cable tie - up to 4 units are individually tied to each ring. The emergency blood should remain stored in the emergency fridge tied to the ring. The cable tie should only be cut when the unit is removed to be transfused. Where the cable tie is cut and the unit is unopened or unused, we will charge for the blood, irrespective of whether it was stored in a fridge.

Therapeutic phlebotomy is available for individuals who have been diagnosed with Polycythaemia or Haemochromatosis who may choose to have their phlebotomies performed by the Blood Service.

What is therapeutic phlebotomy?
Individuals may require therapeutic phlebotomy if their body produces too many red cells or absorbs too much iron. It is similar to regular donation, except that the clinician has prescribed it as a form of medical treatment. It’s safe, inexpensive and monitored by trained medical staff.

The medical conditions for which this procedure may be required are as follows. 

Polycythaemia
When there are too many red cells circulating in the individuals blood, it could make it thicker, which may lead to complications. Blod clots may form, which could lead to strokes, heart attacks or pulmonary emboli.

Haemochromatosis
Hereditary haemochromatosis is a genetic condition in which there is excessive absorption of dietary iron, resulting in iron overload. This may cause damage, particularly to the liver, pancreas and heart. Diagnosis is confirmed by genetic blood tests and iron studies.

What does the treatment entail?
As mentioned, the clinician will prescribe therapeutic phlebotomies at regular intervals. It may take a few months or longer for the individuals blood results to reach normal levels and treatment will continue throughout the individuals life.

The initial phlebotomy must be performed at the WPBTS Headoffice in  Pinelands, cape Town or at the Regional branch in Paarl, Worcseter and George. Thereafter, individuals may donate at any of our donor clinics, if they meet all the health criteria.

Are there costs involved?
Because we cannot use the first treatment for transfusion purposes, there will be a cost involved. Subsequent donations will be accepted for use if the donation criteria are met.

How do I register?
With the aid of your clinician, please fax or e-mail the completed forms to us.

Download registration forms

The WPBTS is dedicated to providing the safest blood products and services to the community. We also respect the fact that individuals may prefer to receive blood from donors who they know. That is why we offer the service of designated donation, which is the opportunity to use compatible blood from a family member or friend.

What are the requirements?
To consider designated donation, the individual must fulfil the acceptance requirements of regular blood donors. Their decision to donate must be entirely voluntary. If the donor has travelled to a malaria area and taken prophylaxis, the patient may agree with informed consent, for the donor to be accepted. WPBTS medical staff will discuss with the patients doctor, the administering of malaria prophylaxis to the patient.

It is not advisable for a woman of childbearing age to receive blood from her spouse or his relatives as this could lead to a blood group incompatibility that can affect the safety of future pregnancies.

Should the donor be deferred from donating, neither the prospective patient nor the doctor will be informed of the reason.

How does it work?
The surgeon will decide on the number of units required for surgery. The donation schedule will be planned in advance. It takes at least 48 hours to test and process a unit of blood.

The patient and donors’ blood group will be tested in order to select suitably matched donors. The patient will be screened for irregular antibodies. Should the patient have irregular antibodies the donors will be typed for the corresponding antigen(s). Only compatible donors will be selected for donating.

Infants less than 4 months old should receive group specific cellular blood products provided the ABO and Rh group have been established by clear agglutination and reverse grouping. The transfusion schedule should be continued using the same blood group. Eg. if the transfusion programme was started with Group O, then only Group O should be continued to be administered.

For infants and young children FFP should be group specific or group AB.

Platelets should be group specific or if unavailable low titre group.

All units donated from first and second degree relatives must be gamma-irradiated in order to prevent graft versus host disease. The irradiation is done to a minimum dose of 25 Gy as close to the time of transfusion, preferably within 12 hours.

When a male spouse donates for his female partner of childbearing age, the units of blood should be filtered in order to reduce the risk of leucocyte and platelet antibody development in subsequent pregnancies. All infants less than 12 months should receive leucocyte reduced products.

What tests are performed?
Designated donations undergo the same mandatory testing as regular blood donations. In addition, a full blood count is performed on the donor.

Donors who are NAT reactive, Anti-HIV 1/2, HBsAg or Anti-HCV reactive will not be accepted onto the designated programme and will be counselled individually.  

Units which are TPHA reactive or have cross reactive results on any of the tests, may be issued with the CEO/ Medical Director’s permission, in consultation with the patient’s doctor.

The doctor, anaesthetist and ward sister will be informed of the total number of designated units collected for the prospective patient and whether the patient has requested that he/she refuse blood from the allogeneic supply should the designated unit(s) be insufficient for their requirements. Designated blood units will be labelled with an orange designated tag and sticker.

Compatibility testing is performed on designated donations. The doctor should submit the routine cross-match laboratory request to Blood Bank.  This request will be labelled with an orange sticker specifying designated  donation. WPBTS staff will check with patient’s doctor about the disposal or retention of FFP units.

The Specialised Donation Information Leaflet, service tariff and sample quotes will be sent to the doctor and patient.

Costs
A designated unit of blood costs the same as that from the general blood supply. A designated procedure is however billed, to cover the cost of the administration and additional blood tests i.e. full blood count. The designated donations/procedure should be pre-authorised by the individuals’ medical aid. Additional costs for irradiation.  Transportation costs.

Designated blood donations which are not used will only be transferred to the general blood supply if donated by a regular donor who has donated within the past 12 months and who meets the regular blood donation acceptance criteria.

How to register
The patients consent for designated donation and the doctors’ request form should be completed and returned by fax to the WPBTS Specialised Donation Unit.

The information will be reviewed to assess the individuals’ suitability for donation. The prospective designated donors will be contacted, to schedule the appointment(s) for the venesection programme.  The donations will take place at our Specialised Donation Unit or fixed site blood donation centre by appointment.

Download registration forms