Liver Transplant Protocol 3364-108-406

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					  Name of Policy:         Liver Transplant Protocol
                                                                                                    ii-IF   lVrHSlT\-   ur
  Policy Number:          3364-108-406                                                             'T'()l,EI)0
  Department:            Pathology/Laboratory - Blood Bank
  Approving Officer':    Associate Professor
                         Director, Clinical Pathology/Hematopathology
  Responsible Agent:     Core Lab Coordinator
                           (Michelle Bartkowiak, MT(ASCP)SBB)
                         Manager, Lab (Cynthia O'Connell)
  Scope:                 Pathology/Laboratory - Blood Bank                          Effective Date:         6/9/2008
                                                                                    Initial Effective Date: 2/2000

             New policy proposal                       _ _ _ Minor/technical revision of existing policy
             Major revision of existing policy         _--=-X=--_ Reaffirmation of existing policy


(A) Policy Statement

The Blood Transfusion Service will respond by specific procedures when liver transplant protocol (LTP) is
initiated" The attending physician initiates LTP when a patient is admitted or prepared for liver transplant.

(B) Purpose of Policy

To expedite and anticipate blood product requirements in liver transplant surgeries"

(C) Procedure

Section 1: Initiation ofLTP
1. The Blood Transfusion Service is notified immediately when liver transplant is anticipated.
2" The Department of Pathology will ensure that the Blood Transfusion Service has adequate staffing to
   provide for increased blood demands by calling in additional personnel when necessary.
3" The "Request for Blood Transfusion" stating "Liver Transplant Protocol" will be submitted with the Blood
   Bank specimen" A Blood Bank specimen must be collected and sent to the BTS as soon as possible. Two
   (2) PINK tubes must be labeled with orange Blood Bank ID labels/numbers with the following information
   completed: Patient's first and last name and hospital ID number, initials of phlebotomist, date and time of
   specimen collection" The corresponding Blood Bank ID number armband must be attached to the patient at
   that time in order for subsequent Type-Specific/Compatible or crossmatched transfusions to be given.

Section 2: Red Blood Cells

1" Perform the ABO & Rh Type/Antibody Screen (T&S) immediately upon receipt of the specimen.
   Crossmatch ten units (10) LRC within one hour when notified that transplant will proceed. Maintain an
   inventory of an additional twenty units of the patients blood type or type compatible at UMC Blood Bank at
   all times throughout the procedure" Consult table below to determine ABO-compatible type to switch to in
   the event of inadequate supply of type-specific RBC. Issue ten units to OR at the beginning of surgery. At
   that time, crossmatch an additional ten (l0) LRC for reserve in the Blood Bank. Keep ten (l0) units LRC
   ahead at all times"
2. Crossmatch Rh positive RBC for all Rh negative patients except female patients with child-bearing
   potential and patients already exhibiting anti-D.
3. NotifY the BTS Medical Director immediately when incompatibility or positive antibody screen is detected.
   The BTS Medical Director notifies the surgical team that delay in blood availability is possible. The BTS
   Medical Director determines if the available blood supply warrants issue of AHG-incompatible or antigen
   positive RBC temporarily during the surgery,
 Policy 3364-108-406
 Liver Transplant Protocol
 Page 2


                                       0                      A                      B                   AB
 Patient Type
 Donor Type RBC                       0                  AorO                   BorO                  ABorA
 Donor Type Plasma                All types              AorAB                  BorAB                  AB

 Section 3: Thawed Plasma
 1.. Thaw ten (10) FFP when notified transplant will proceed.. Issue 10 units to OR at the beginning of the
     surgery.
 2.. Thaw ten (10) additional FFP when the first ten units have been issued.. (Stay 10 thawed units ahead and
     maintain an inventory of at least 20 frozen units at all times).

Section 4: Platelets
1. Four units Platelets, Pheresis (LRSDP) will be requested STAT from ARC when notified transplant will
   proceed.. Platelets should be available 30 to 45 minutes after request.
2. When all platelets at UMC have been issued, ask surgery team if additional platelets should be reserved..
   Order additional platelets from ARC if necessary..

Section 5: Cryoprecipitated AHF
Thaw ten units of cryoprecipitate four hours after the first ten RBC are issued to surgery (sooner if requested by
attending surgeon or anesthesiologist).. Do not pool the cryoprecipitate until requested by surgery. Inquire for
further orders each time cryoprecipitate is issued.

    Approved by:                                                                         ReviewlRevision Date:
                                                                                         2/00
                        _.&}          ~           t--- t -ot
                                                                                         8/00
                                                                                         7/01
    Robert L Booth, Jr, MD..                                      Date                   1105
    Associate Professor                                                                  112008
    Director, Clinical Pathology/Hematopathology                                         6/9/2008
    Review/Revision Completed By:
      Michelle Bartkowiak, MI(ASCP)SBB
                                                                                         Next Review Date: 6/112011
Policies Superseded by This Policy:
  It is the responsibility of the reader to verify with the responsible agent that this is the most current version of the policy

Reference:
AABB Standards for Blood Banks and Transfusion Services, cunent edition.
Technical Manual, American Association of Blood Banks, current edition.