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TM Medical Policy Manual

Last Modified: July 30 2010

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TM Medical Policy Manual

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This manual presents optimal Transfusion Medicine practice guidelines for all levels of physicians responsible for Transfusion Medicine services in British Columbia.

TMAG (Transfusion Medicine Advisory Group) released the First Edition in 2007. Sections 4 and 7 were revised January 1, 2009.

Table of Contents

The Table of Contents provides a quick reference to the manual contents.

Glossary of Terms and Abbreviations

The Glossary of Terms and Abbreviations provides a definition of the terms and abbreviations used in the manual.

Introduction

Introduction to the manual and overview of the intended audience and applicable standards.

An overview of the role and responsibilities of the TM Medical Director (or designate) is provided at the end of the module.

This section includes the title page and copyright information if the manual is printed from the pdf modules.

Section 1.0 Medical Roles and Responsibilities

Section 1.0 includes policies applicable to Transfusion Medicine Medical Director (TM-MD) medical roles and responsibilities.

Specific policies are described in this subsection and tables:

1.1 Policies and tables applicable to the indications for Consultation with the TM-MD or Designate by TMS Staff

Table 1: Call Pathologist Immediately

Table 2: Call Pathologist as Soon as Possible

Table 3: Transfusion Emergency and Pathologist Not Responding

Section 2.0 Quality System Management

Section 2.0 includes policies applicable to the TM-MD and Transfusion Medicine Service (TMS) staff as related to the management of the TMS quality system.

Specific policies are described in this subsection:

2.1 Components of Assessment QSE

Transfusion Committee

Audit and Utilization Management

Adverse Events and Error Management

Section 3.0 Informed Consent and Refusal of Consent

Section 3.0 includes policies applicable to the TM-MD, Transfusion Medicine Service (TMS) staff, Treating Physician, and Treating Nurse as related to the informed consent, and refusal of consent, process.

Section 4.0 Daily operations (Revised 01 January 2009)

Section 4.0 includes policies applicable to the TM-MD and the Transfusion Medicine Service (TMS) staff as related to the processes and procedures that define regular, daily operations. This section was reviewed and revised in January 2009 to reflect changes in practice related to the Weakened Expression of the D-Antigen examination.

Specific policies are described in these subsections and tables:

4.1 Patient Identification and Sample Labelling Criteria

4.2 Pre-transfusion Examinations

Table 4: Clinical Significance of Antibodies and Provision of Red Cells

4.3 Transfusion Reaction Investigation

Table 5: Investigation and Documentation of Transfusion Reactions by the TMS Laboratory

Table 6: Symptoms, Differential Diagnosis and Recommended Approach to Investigation of Transfusion Reactions

4.4 Inventory Management

Section 5.0 Appropriate Use of Blood Components for Adults

Section 5.0 includes policies applicable to the TM-MD and to the Transfusion Medicine Service (TMS) staff as related to the appropriate use of blood components for adults.

Specific policies are described in these subsections and tables:

5.1 Transfusion of Red Cells to Adults

Table 7: Transfusion of Red Cell Units to an Adult

Table 8: Selection Order of ABO Compatible Donor Red Cells

5.2 Transfusion of Platelets to Adults

Table 9: Guidelines for Platelet Transfusion in Adults

Table 10: Relative Contraindications to Adult Platelet Transfusion

5.3 Transfusion of Frozen Plasma to Adults

5.4 Transfusion of Cryosupernatant Plasma to Adults

5.5 Transfusion of Cryoprecipitate to Adults

Section 6.0 Special Product Selection

Section 6.0 includes policies applicable to the TM-MD and to the Transfusion Medicine Service (TMS) staff as related to the selection of special blood components.

Specific policies are described in these subsections and tables:

6.1 Platelet Selection

Table 11: Selection Order of ABO Group for Platelets

6.2 Indications for Irradiation of Blood Components

Table 12: Indications for Use of Irradiated Blood Components

6.3 Indications for Anti-CMV Negative Red Cells and Platelets

6.4 Indications for Washed Red Cells and Platelets

6.5 Indications for HLA-matched Platelets

6.6 Emergency Release of Red Cell Unit(s)

These policies include the responsibilities of the Treating Physician and Treating Nurse.

Section 7.0 Appropriate Use of Other Blood Products (Revised 01 January 2009)

Section 7.0 includes policies applicable to the TM-MD and to the Transfusion Medicine Service (TMS) staff as related to the appropriate use of blood products, predominantly Albumin and IVIG. This section was reviewed and revised in 2009 to include the 2007 Guidelines for Albumin Use in Adults in BC, and changes made to the IVIG Program in BC.

Specific policies are described in these subsections and tables:

7.1 Appropriate Use of Plasma Fractionated Products

7.1.1 Indications for the Use of Albumin

Table 7.1.1 A: Indications for which albumin MAY be used

Table 7.1.1 B: Indications for which albumin should NOT be used

7.1.2 Indications for the Use of IVIG

Table 7.1.2 A: List of Approved Medical Conditions for IVIG Use

7.1.3 Indications for the Use of Other Plasma Fractionated Products

Table 13: Plasma Fractionated Products that Require SAP (SPR) Approval

Table 14: Plasma Fractionated Products that Do Not Require SAP (SPR) Approval

7.2 Appropriate Use of Recombinant Products – Recombinant Factors VIIa, VIII and IX, Erythropoietin

Table 15: Recommended Dosing for Recombinant Factors VIIa

Section 8.0 Appropriate Use of Blood Products in Neonates or Pediatric Patients

Section 8.0 includes policies applicable to the TM-MD and to the Transfusion Medicine Service (TMS) staff as related to the appropriate use of blood products in neonates or pediatric patients.

Specific policies are described in these subsections and tables:

8.1 Neonatal Red Cell Transfusion

Table 16: Threshold and Target Hemoglobin Levels for Neonatal Red Cell Transfusion

8.2 Neonatal Platelet Transfusion

Table 17: Indications for Neonatal Platelet Transfusion

8.3 Pediatric Blood Product Transfusion

Table 18: Pediatric Red Cell Transfusion Guideline Table

8.4 Transfusion of Frozen Plasma to a Pediatric Patient

8.5 Management of Congenital Hemolytic Anemias

8.6 Transfusion Management of Autoimmune Hemolytic Anemias in Pediatric Patient

(See Section 9.3: Transfusion Management of Autoimmune Hemolytic Anemia.)

Section 9.0 Special Transfusion Scenarios

Section 9.0 includes policies applicable to the TM-MD and to the Transfusion Medicine Service (TMS) staff as related to special transfusion scenarios.

Specific policies are described in these subsections and tables:

9.1 Support of a Patient with Signed Refusal of Consent for Transfusion

These policies include the responsibility of the anesthetists/surgeons/treating physician.

9.2 Management of Patient requiring Massive Transfusion

9.2.1 Switching ABO group in Massive Transfusion or During Inventory Shortage

Table 19: Selection Order of ABO Compatible Donor Red Cells

Table 20: Selection Order of ABO Group for Platelets or for Plasma

9.2.2 Switching from D-negative to D-positive in Massive Transfusion

9.2.3 Massive Transfusion in Recipient with Alloantibodies

9.3 Transfusion Management of Autoimmune Hemolytic Anemia

9.4 Transfusion Support of Minor Incompatible Solid Organ Transplant Recipients

Table 21: ABO Groups of Red Cells and Plasma in Post-transplant Patients

9.5 Transfusion Support of Allogeneic Stem Cell and Bone Marrow Transplant Recipients

Table 22: Guideline for Transfusion of Stem Cell or Bone Marrow Transplant Recipients Before and Following Serologic Engraftment (defined as no mixed field agglutination in forward or reverse typing)

Section 10.0 Disaster Plans

Section 10.0 includes policies applicable to the TM-MD and to the Transfusion Medicine Service (TMS) staff as related to the development and implementation of disaster plans that may be specific to the TMS, or broaden out to include the Health Authority.