Administration Guide

• Temper the blood, if it was refrigerated, until it reaches a temperature of between 25 and 35º C, by immersing the bag in water at 37º C. During the transfusion, the product must be kept at about 30-35ºC.

• Lactated Ringer's, dextrose solutions, or other calcium-containing products should never be mixed with any blood product containing citrate as an anticoagulant, as calcium could cause clotting in the transfusion system. Only 0.9% NaCl should be used. If concentrated red blood cells are transfused, 50-70ml of 0.9% NaCl should be added to reduce their viscosity.

• Always use specific infusion sets for transfusions (with filter) to prevent the passage of clots or cellular aggregates. These filters usually have a diameter of 170 microns. For small volumes of up to 50 cm3 of blood, the HEMO-NATE filter can be used, which we will attach to the system.

• Calculate the volume to transfuse. It is important to calculate the amount of blood or red blood cell concentrate that we have to administer and, in addition, subtract this volume from the total fluids that the patient will receive that same day to avoid vascular overload. We can calculate the volume to be transfused using the following formula:

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Q = P x 88 x (Htc1-Htc2)/Htc3Q: volume to be transfused (ml)

P: receiver weight (kg)
Htc1: desired hematocrit
Htc2: recipient hematocrit
Htc3: donor hematocrit

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There are other simpler rules to calculate the volume to be administered. For example, assuming a product hematocrit of 50%, by transfusing 2.2 ml/kg of this whole blood, we will obtain an approximate 1% increase in the recipient's hematocrit. If it is a concentrated red blood cell, we will obtain a 1% increase when transfusing 1ml/kg. The maximum dose for whole blood transfusion is 22ml/kg/day.

• Once the transfusion is finished, the hematocrit must be checked 1 or 2 hours later to see if the increase obtained is the one calculated by the formula. In any case, until 24 hours after the transfusion and in the absence of bleeding or hemolysis processes, the hematocrit does not completely stabilize. At least 70% of the transfused red blood cells must be preserved 24 hours later to consider the transfusion successful. The half-life of a transfused red blood cell is between 21 and 48 days.

• If the bag of blood or concentrate remains without refrigeration for more than half an hour, we must administer the product within a period of less than 6 hours or we can refrigerate it again but the expiration date will be 24 hours. Blood is an excellent culture medium and poor handling could lead to contamination of the product.

• The speed of administration will depend on the pathology and the patient. During the first half hour of the transfusion, the rate will be slow, about 2-3ml/kg/h. In this way we will control the possible appearance of adverse effects. If there are no complications, we will increase the rate to 10ml/kg/h until the transfusion is completed. In cardiac patients, at risk of vascular overload, the rate should not exceed 4ml/kg/h. In patients in hypovolemic shock, the rate can be increased to 20ml/kg/h.

• Throughout the entire process and up to 1 hour after the transfusion, we must closely monitor the pulse, temperature, color of the mucous membranes, CRT, and heart and respiratory rates.