Blood Component Transfusion Guidelines |
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Indications for red blood cell transfusions
A. Acute anemia: Patients should be symptomatic and normovolemic. Crystalloid infusion should be used initially to correct hypovolemia.
- Hemoglobin < 7 g/dL in a normal, healthy individual
- Hemoglobin < 9 g/dL in patients at increased risk from bleeding. Patients at increased risk from bleeding include:
Elderly patients >65 years old
Patients at risk of heart disease
Patients at risk for cerebrovascular disease
Patients with chronic obstructive pulmonary disease
Patients on sympatholytic medications
B. Chronic anemia: Treatable causes of anemia should be ruled out first, including iron, folate, or vitamin B12 deficiencies.
- Patient should be symptomatic and transfusion is based on clinical judgment
- Do not transfuse to reach an arbitrary hemoglobin
C. Perioperative use: Young, healthy adults undergoing surgery can tolerate hemoglobin levels between 7 and 9 g/dl. Volume should be replaced with crystalloids and red cells transfused only if the patient becomes symptomatic. Autologous blood is preferred for elective surgery.
- Preoperative hemoglobin < 8 g/dL with an operative procedure associated with major blood loss (>1000 ml) in a previously healthy individual
- Preoperative hemoglobin < 10 g/dL in a patient at risk from bleeding
- Intraoperative patients at risk with unstable vital signs
- Surgical blood loss>1000 mL
D. Prophylactic use:
- Sickle cell disease with sickle cells > 20%
Indications for saline washed red blood cells
- Severe febrile transfusion reactions not prevented by leukocyte reduction
- Patients with IgA deficiency (if products from IgA deficient donors are not available)
- History of anaphylactic transfusion reaction
- Severe urticarial reactions unresponsive to antihistamines
Indications for platelet transfusion
Decreased platelet production:
- Prophylaxis against spontaneous hemorrhage when:
- Platelet counts are < 10,000/uL
- Platelet counts are < 20,000/uL with fever, infection or similar condition
- Platelet counts between 10,000 and 50,000/uL with any of the following:
headache
continued bleeding from a wound or surgical incision
retinal hemorrhage
confluent petechial hemorrhage.
- Bleeding patients with platelet counts < 50,000. Bleeding includes microvascular bleeding, epistaxis, hematuria, and suspected or proven internal bleeding
- Prophylaxis prior to surgery or invasive procedures when platelet count < 50,000/uL
Increased platelet destruction or consumption
- Intraoperative use:
- Platelet count < 50,000/uL and nonmechanical or microvascular bleeding
- Neuro, middle ear, or ophthhalmologic surgeries with platelet count < 100,00/uL
- Ventricular assist devices, cardiopulmonary bypass, or intra-aortic balloon pump with platelet count < 100,000/uL
- Following massive transfusion of RBC's if platelet count < 50,000/uL and continued non-mechanical bleeding
- Patients with hypersplenism, sepsis, or DIC& platelet count < 50,000/uL
- ITP if severe hemorrhage. Consider intravenous immune globulin
- TTP and HUS (hemolytic uremic syndrome)-avoid platelet transfusions, if possible and consider plasma exchange. Platelet transfusions may be indicated if platelet count < 10,000/uL or severe hemorrhage
- Fetal alloimmune thrombocytopenia
Qualitative platelet defects:
- Congenital-only if bleeding or severe prolongation of bleeding time. HLA matched platelets are preferred. Consider desmopressin (DDAVP).
- Acquired-Platelets are of limited benefit and should be reserved for severe hemorrhage only. Consider cryoprecipitate, desmopressin, and dialysis for uremia.
- Platelet antagonists: Many drugs cause platelet function defects. Among the current commonly used drugs that affect platelet functions are :
- Aspirin.
- Plavix (clopidogrel)
- Reopro(abciximab)
- Integrilin (eptifibatide)
- Aggrastat (tirofiban)
- Angiomax (bivalirudin)
Indications for Fresh Frozen Plasma (FFP)
- Microvascular bleeding with INR >1.5 times midpoint of normal range or activated partial thromboplastin time (APTT) >1.5 times the upper limit of normal.
- Massive transfusion and continued bleeding with laboratory evidence of coagulopathy.
- Urgent reversal of warfarin (coumadin) to stop bleeding or prior to emergency surgery.
- Acquired or congenital coagulation factor deficiencies of V or XI in bleeding patients or prior to surgery or an invasive procedure.
- Deficiency of antithrombin III, heparin cofactor II, protein D, or protein S when specific factor concentrate is not available.
- Plasma exchange for thrombotic thrmobocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS).
- Prophylactic treatment of patients with hereditary angioedema prior to dental procedures or head and neck surgery.
Indications for Cryo Poor Plasma
- Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), if FFP is not effective.
Indications for Cryoprecipitate
- Hypofibrinogenemia (fibrinogen < 100mg/dL) associated with consumptive coagulopathy.
- Congenital hypofibrinogenemia or dysfibrinogenemia if bleeding or undergoing surgery or an invasive procedure.
- Factor XIII deficiency if bleeding or undergoing surgery or an invasive procedure.
- Von Willebrand's Disease when Factor VIII concentrates containing multimeric vWF are not available.
- Hemophilia A (Factor VIII deficiency) when Factor VIII concentrates are not available.
- Qualitative platelet defects (prolonged bleeding time or abnormal platelet aggregation studies) resulting from uremia (BUN >60mg/dL) or nonsteroidal anti-inflammatory drugs if bleeding or undergoing surgery or an invasive procedure.
- Fibrin glue (cryo bandage) for localized bleeding or a surgical procedure (if Hemaseel or Tisseel not available in Pharmacy).
- Prophylactic administration to avoid localized DIC associated with head trauma.
Indications for Irradiated Components
- Recipients of bone marrow and peripheral blood stem cell transplants.
- Fetal transfusions
- Newborns:
- who have received intrauterine transfusions
- undergoing exchange transfusion
- receiving platelet transfusions
- Directed donor units from blood relatives
- Patients with Hodgkin's disease.
- Children with primary immunodeficiency
- Granulocytes
Indications for CMV Negative Components
Leukocyte reduced components are considered to be equivalent to CMV negative except in the following situations:
- Fetal transfusions
- Neonatal transfusions
Indications for Factor VIII Concentrate
- Hemophilia A (Factor VIII deficiency)
- Von Willebrand's Disease
Indications for Factor IX Concentrate
- Hemophilia B (Christmas disease)
Indications for Factor IX Complex
- Factor VIII deficiency with inhibitors
Factor VIIa
- Factor VIII deficiency with inhibitors
- Factor VII deficiency
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