Blood Products and Indications
Packed red
blood cells
(PRBCs)
For hemodynamically stable patients without active bleeding:
- Hgb < 7 g/dL - Generally indicated
- Hgb 7 - 8 g/dL - Consider in pre-op Pts & Pts w stable cardiovascular disease
- Hgb 8 - 10 g/dL - Consider in select Pts only (symptomatic anemia, cardiac ischemia).
For actively bleeding patients, transfuse as needed to maintain adequate oxygenation
Notes: 1 U PRBC ≈ 300mL, 1 U PRBC =>↑Hb ̴ 1 g/dL, Large trxn→↓Ca,↑K, ↓ Coagulation factors
Platelets
(plts)
- <10,000/μL Generally indicated or <20,000/μL w/ infection/line placement/minor biopsy
- <50,000/μL With active bleeding or prior to moderate-high risk invasive procedure
- <100,000 Neurosurgery or ocular surgery
*Threshold-based trxn not appropriate for Pts bleeding 2° to platelet dysfunction
Notes: 1 U Apheresis plt ≈ 300mL ≈ “6 pack” of pooled plts =>↑plt count ̴ 25,000 /μL.
Refractory = Pts with < 5000/μL plt ↑ 15-60 min post txn x 2 after r/o other causes (e.g. drugs)
Plasma
(FFP)
- Correction of bleeding 2° to↓ in multiple coag factors ( eg, warfarin, vit K def, DIC, liver
disease, dilution) Consider lower risk coagulation factor complex (e.g. Bebulin)
- Prophylactic use in non-bleeding Pts prior to mod-high risk procedures when INR>2.*
*Available studies do not support the efficacy of FFP as prophylaxis for most invasive
procedures in patients with a mild coagulopathy (ie, INR <2.0)
Notes: 1U FFP ≈ 250mL, Initial dose: 15 mL/kg ( ̴ 3 to 5 units of FFP for average adult).
Transfuse close to time of procedure due to short half-life of coagulation factors
Cryoprecipitate
(Cryo)
- Correction of significant bleeding 2° ↓fibrinogen (<160)
- Emergency use for bleeding in vWD Pts
Irradiated
(IRR)
To prevent Txn-assoc. GVHD (eg, in Pts w/cellular immune-def, stem cell recipients,
premature neonates, heme malignancies, and Pts receiving Fludarabine or Cladribine,
HLA matched plts or directed units.) *May cause delay in availability
Notes: 1 U of cryo ≈ 10-20 mL, 10U of cryo will ↑ fibrinogen 7̴ 0 mg/dL in 70kg Pt
Leukoreduced
To ↓ Risk of febrile rxns, ↓ risk of trxn transmission of CMV.
Washed
To ↓ risk of allergic rxns for Pts with h/o prior severe allergic rxn. Rarely indicated.
NOT recommended for platelets (reduces yield ~ ½, plts less functional)
Notes: Risk of CMV transmission w/ leukoreduction ≈ risk w/CMV sero-negative products
**All blood products at UNM (with the exception of granulocytes) are pre-storage leukoreduced**
Premedication with acetaminophen is only advised for patients already receiving anti-pyretics.
Premedication with diphenhydramine is only advised for patients with REPEAT allergic reactions.
-Type and Screen: Determines ABO type & Rh status
and screens for non-ABO RBC antibodies.
- AT UNMH, crossmatch is done when orders to
transfuse are submitted in Powerchart. Blood is held
by blood bank until pick up at time of transfusion.
Blood product consent form checklist:
 Reasons for transfusion
 Risks of transfusion vs benefit
 Alternative treatments (if any)
** Must give Pts opportunity to ask questions!**
UNMH Blood Bank 272-0992
Transfusion Complication
Risk per UNIT
Allergic
3:100
Febrile (Leuko-reduced Units)
1:100
TACO
1:100
TRALI
1:5,000
Sepsis
1:5,000
Acute hemolytic
1:75,000
HBV
1:160,000
HIV & HCV
1:2 million
STOP
Transfusion
Transfusion
Reaction
Suspected
- Stabilize patient
- Notify attending
- Perform Clerical Check
Fill out Trxn Rxn form & call Blood Bank
All other symptoms
Trxn can resume
AFTER symptoms
resolve (Rx with
diphenhydramine)
Draw 2 purple tops and send to BB with remainder
of unit for trxn rxn work-up. Send urine if s/s of
hemolysis. Unless emergent, wait for results and
pathology approval to transfuse another unit.
Febrile nonhemolytic
Allergic/
Anaphylactic
TACO
TRALI
Sepsis
(Transfusion –
Assoc. Circulatory
Overload)
Symptoms & Signs*: Fever, chills, hypotension, dyspnea, chest pain, flank pain, and anxiety
Severity: Life threatening
Ddx: Febrile Non-Hemolytic, Sepsis, TRALI
Prevention & Tx: Proper ID of Pt and blood product. Only transfuse RBC with normal saline.
Maintain urine output (IV fluids, mannitol and/or diuretics), CV support.
Symptoms & Signs*: Dyspnea, hypertension, hypoxia, pulmonary edema, ↑BNP
Severity: Moderate morbidity to life threatening
Ddx: TRALI, Acute Hemolytic Transfusion Rxn, Anaphylaxis, Non-Txn ARDS
Prevention & Tx: Conservative transfusion, ID at risk Pts (eg, elderly, h/o heart disease, and
pediatric Pts) and transfuse slowly over max of 4hrs . Rx with supplemental O2 and diuretics.
(TransfusionRelated Acute
Lung Injury)
Symptoms & Signs*: Urticaria, pruritus Anaphylaxis =>Dyspnea, tightening of throat, ↓BP
Severity: Low morbidity (simple allergic) to life threatening (anaphylaxis)
Ddx: TRALI, TACO (consider both in Pt’s with shortness of breath)
Prevention & Tx: Reactions dose-dependent => STOP Trxn and wait for symptoms to resolve
with treatment. For repeated rxns, consider pre-medication with diphenhydramine, famotidine
and/or steroids. Rx anaphylaxis w/ Epi. Consider washed units for Pts with h/o anaphylaxis.
Acute
Hemolytic
Acute Transfusion Reactions
Symptoms & Signs*: Fever (>1C°↑ and >38°) and chills
Severity: Low morbidity
Ddx: Acute Hemolytic Rxn, Sepsis & TRALI
Prevention & Tx: Prevented by using leukoreduced products.
In RCTs acetaminophen not shown to ↓ incidence; premed advised only if Pt is already febrile.
Symptoms & Signs*: SOB, fever, hypoxia, pulmonary edema, ↓ BP, within 6 hrs of transfusion.
Severity: Life threatening
Ddx: TACO, Sepsis, Acute Hemolytic Transfusion Reaction, Anaphylaxis, non-Trxn ARDS
Prevention & Tx: Conservative transfusion. Treat like ARDS.
Symptoms & Signs*: Hypotension, fever, and rigors
Severity: Life threatening
Ddx: Acute Hemolytic Transfusion Rxn, TRALI, Febrile Non-Hemolytic Rxn
Prevention & Tx: Bacterial testing of blood units. Rx w/antibiotics and supportive care.
* Not all signs and symptoms may be present
2013 UNMH Transfusion Service (Ramos, Reyes, Crookston & Koenig)