Transfusion of labile blood products

We recommend that all countries implement national haemovigilance quality systems. 1B

We recommend a restrictive transfusion strategy which is beneficial in reducing exposure to allogeneic blood products. 1A

We recommend pathogen inactivation for fresh frozen plasma (FFP) and platelets. 1C

We recommend that labile blood components used for transfusion are leukodepleted. 1B

We recommend that blood services implement standard operating procedures for patient identification and that staff be trained in early recognition of, and prompt response to, transfusion reactions. 1C

We recommend a male-only donor policy for plasmacontaining blood products to prevent the onset of transfusion-related acute lung injury (TRALI). 1C

We recommend that all red blood cell (RBC), platelet and leukocyte donations from first-degree or seconddegree relatives be irradiated even if the recipient is immunocompetent, and all RBC, platelet and leukocyte products be irradiated before transfusing to at-risk patients 1C

Allogeneic blood transfusion is associated with an increased incidence of nosocomial infections. B

Storage lesions
We recommend that RBCs should be transfused according to the first-in, first-out method in the blood services to minimise wastage of erythrocytes. 1A

Cell salvage
We recommend the use of red cell salvage which is helpful for blood conservation in major cardiac and orthopaedic surgery. 1B

We recommend against the routine use of intraoperative platelet-rich plasmapheresis for blood conservation during cardiac operations using cardiopulmonary bypass (CPB). 1B

We recommend that cell salvage is not contraindicated in bowel surgery, provided that the initial evacuation of soiled abdominal contents is undertaken, additional cell washing is performed and broad-spectrum antibiotics are used. 1C

We suggest that cell salvage is not contraindicated in cancer surgery, provided that blood aspiration close to the tumour site is avoided and leukodepletion filters are used. 2C

Plasma and platelet transfusion
We recommend against the use of plasma transfusion for pre-procedural correction of mild-to-moderately elevated INR. 1C

We recommend early and targeted treatment of coagulation factor deficiencies in the plasma. Sources of coagulation factors are coagulation factor concentrates, cryoprecipitate or high volumes of plasma, depending on the clinical situation, type of bleeding, type of deficiency and resources provided. 1B

In the treatment of acquired coagulation factor deficiency, we suggest the consideration of a ratio-driven protocol (RBC : plasma : platelet concentrates) early in uncontrolled massive bleeding outside the trauma setting followed by a goal-directed approach as soon as possible. 2C

We suggest coagulation factor concentrates for the primary treatment of acquired coagulation factor deficiency due to their high efficacy and their minimal infectiousness. 2C

We recommend against indiscriminate use of plasma transfusion in perioperative bleeding management. 1C

We suggest platelet concentrate transfusion in bleeding situations clearly related to antiplatelet drugs or thrombocytopaenia less than 50x109l-1. 2C