TM Medical Policy Manual

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 30 July 2010)


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. The section was further revised in July 2010 as Transfusion Reaction was moved to a new section of the manual.

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 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.


Section 11.0 Transfusion Reactions


Section 11.0 includes policies applicable to the TM-MD and to the Transfusion Medicine Service (TMS) staff as related to the identification, investigation and management of transfusion reactions.

Quick reference material is provided in these tables:
Table 11.1 Signs & Symptoms, Differential Diagnosis and Recommended Approach to Investigation and Management of Transfusion Reactions

Table 11.2 Guidelines for the Investigation of Transfusion Reactions by the TMS Laboratory

Table 11.3 IVIG Infusion Reaction Classification and Management

Table 11.4 Recommendations for Pathologist Comments – Transfusion Reaction Report