Blood Products and Transfusion Indications
Red Blood ...

Blood Products and Transfusion Indications

Red Blood Cells 

 • Indications

    - Hgb <7 (NEJM 2014;371:1381, NEJM 2013;368:11)

    - Hgb <8 if CAD/ACS, ortho/cardiac surgery

    - AIHA and MDS (no specific Hgb threshold)

    - Sickle cell disease (see Anemia: Sickle Cell Disease)

 • response: 1U ↑Hgb~1

 • pRBCs will not exert same oncotic effect as hyperoncotic colloid (25% albumin) (Hct ~55% diluted in saline)


 • Indications

    - Low platelets or functionally abnormal platelets

    - <10,000: PPX spont bleeding. Consider antifibrinolytics in refractory thrombocytopenia in CA 

    - <50,000: major bleed, intra- or post-op surgical bleed, ppx prior to invasive operative procedures (no data)

    - <100,000: post-bypass bleed, ICH/ophthalmic (no data)

    - ITP: if life-threatening CNS/GI/GU bleed; fatal hemorrhage is often preceded by wet purpura (mucus membrane bleeding). Otherwise plts not beneficial.

    - HIT/TTP: avoid PLTs unless bleeding

- Assess response at 30-

60m: 1U ↑ PLT ~ 30K.

 • No evidence that apheresis platelets > whole blood derived platelets.

 • No evidence that platelets reverse antiplatelet agents

Fresh Frozen Plasma

 • Indications

    - Active bleed d/t deficiency in multi coag. factors or isolated coag factors for which concentrate is not available

    - Cirrhosis: consider anti-fibrinolytics instead. Treating INR with FFP will likely ↑ bleeding due to ↑ portal pressures.

    - ALF: Consider for ↓Plt or ↑ PT only if bleed or pre-op

    - VKA reversal: IV Vitamin K first. PCC if life-threatening.

    - Trauma, DIC in presence of bleeding, congenital TTP

 • Effect < 6H due to short t1/2 of FVII

 • Assess response: 1U ↑ coagulation activity ~10%


 • Indications

    - Fibrinogen <100: 50-100mg/dL, give 10U; <50, give 20U

    - Advanced liver disease (consider antifibrinolytics instead)

    - Massive transfusion w/ ↓ fibrinogen or abnl ROTEM/TEG

    - Complex cardiac surgery (JAMA 2017;217:738)

    - Postpartum hemorrhage (Br J Anaesth 2015; 114:623)

    - FVIII deficiency, VWD, uremia

 • Fibrinogen replacement: 0.2 bag/kg → 100 mg/dL fibrinogen w/ t1/2 3-5d

 • FVIII or vWF replacement: cryo is last resort therapy

#BloodProducts #Transfusion #Indications #Thresholds #management #hematology #table #comparison #hematology
Contributed by

MGH White Book Manual
Account created for the MGH Internal Medicine Housestaff Manual "White Book" -
Medical jobs
view all


Related content