Liver transplantation requires coordination of the Transfusion Service TS, Liver Transplant LTS , and the Blood Donor Center BDC to prepare blood components for this massive transfusion setting.
- Whoever receives notification of a possible liver transplant should ensure that ALL of the following senior staff are also informed:
- Head, Transfusion Medicine
- Coordinator, Donor Recruitment
- Supervisor, Transfusion Service
- Transfusion Service Supervisor will arrange transfusion service staffing as needed to cover the surgery period and immediate post-operative period.
- The current, up-to-date inventory must be calculated. The following minimum stock must be reserved:
- Twenty (20) packed RBCs
- Twenty (20) FFPs—-leukodepleted and pathogen-inactivated
- Three (3) platelet pools or apheresis doses (each ≥ 2E11 absolute number of platelets)—leukodepleted and pathogen-inactivated.
- The Medinfo Liver Transplant Protocol automatically orders all the above.
- Complex needs:
- If the patient has clinically significant antibodies, confirm the availability of the requested number of antigen-negative/compatible units.
- The Head, Transfusion Medicine, or the covering transfusion medicine consultant on-call will contact the liver transplant team to discuss the feasibility of proceeding after assessing the inventory of antigen-negative units.
- Only the transfusion medicine consultant can approve the use of antigen-incompatible RBCs in conjunction with the liver transplant team.
- Donor Center should increase recruitment/production to meet the anticipated usage as needed.
- When the procedure is confirmed:
- Crossmatch the RBCs by the appropriate technique according to our algorithms (i.e. computer/electronic, immediate-spin, or full AHG).
- Thaw the FFP: the FFP is valid for FIVE days after thawing for use for the transplant patient or other patients with coagulopathy.
- If more than the above number of units is needed, HGH Transfusion Service must inform the Donor Center senior staff (Head, Donor Center; Administrative/Technical Director, and Coordinator, Donor Recruitment) to arrange for additional donations.