Anaemia is common in critical care patients.  Almost exclusively, you will see a fall in Hb over the first few days of admission, unless this is corrected by transfusion.  In most instances, we will opt for a conservative transfusion policy.  There is space at the top of the daily chart for documenting a target haemoglobin, below which nursing staff will be authorised to transfuse blood.

Note that we have access to the ROTEM (thromboelastograph) machine in theatres.  In hours, the ACCU technologists will perform the test.  Out of hours, bleep the trauma ODP.  Please discuss with the consultant before ordering a ROTEM – they are expensive tests and often ordered unnecessarily.

Occasionally, an ACCU patient requires a massive transfusion.  Use the Code Red system to activate blood bank by calling extension 61108, which will always be answered as a priority.  We have a Belmont rapid infuser for use on the unit.

Some patients require specialised treatment of blood products.  The following is extracted from the Barts Health Haematology guidance.  If in doubt, discuss with the haematology SpR.

IRRADIATED RED CELLS / PLATELETS should be requested for the following:

  • Allogeneic bone marrow recipients from time of conditioning chemo/radiotherapy.
  • Allogeneic bone marrow and stem cell donors one month prior to harvest and until harvest(s) completed.
  • Recipients of autologous bone marrow or peripheral blood stem cell transplant from 7 days prior to harvest.
  • All donations from HLA matched donors or first or second degree relatives.
  • Patients with Hodgkin’s Disease.
  • Patients with Aplastic Anaemia.
  • Patients treated with alemtuzumab (Campath-IH/anti-CD52).
  • Patients treated with purine analogue drugs such as fludarabine, 2deoxycoformycin, cladribine, clofarabine, bendamustine.
  • Patients with congenital immunodeficiency states.
  • Intrauterine/foetal transfusion.
CMV NEGATIVE RED CELLS / PLATELETS should be requested for all:

  • Pregnant women regardless of CMV status.
  • Intra-uterine transfusions.

N.B. If a delay in the arrival of CMV negative components could adversely affect a patient then leucocyte depleted components are acceptable.

ALL GRANULOCYTE TRANSFUSIONS must be CMV negative and irradiated.

HEV NEGATIVE COMPONENTS should be requested for the following:

  • Patients awaiting solid organ transplant (SOT) from 3 months prior to the date of planned elective SOT or from the date of listing for a solid organ transplant.
  • Patients who have had a SOT for as long as the patient is taking immunosuppressants
  • Patients with acute leukaemia from diagnosis (unless/until decision made not to proceed with stem cell transplant).
  • Patients awaiting allogeneic stem cell transplant from 3 months prior to the date of planned transplant and up to 6 months following transplant or for as long as the patient is immunosuppressed.
  • Extra corporeal procedures e.g. dialysis, extra-corporeal circulatory support is included if within above indications.

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