Difference between revisions of "Blood products"

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==PRBCs==
+
==Packed Red Blood Cells==
===Usual Dose===
+
===Features===
1 U of PRBCs (250 mL or 3 mL/kg in peds) --> incr Hgb ~1.0
+
#Can give type O Rh-positive pRBCs to a man or woman no longer of child-bearing age
 +
#Options:
 +
###Leukocyte reduced
 +
####Eliminates 70-85% of leukocytes
 +
####Reduces nonhemolytic febrile reactions
 +
####Prevents sensitization in pts who may require bone marrow transplant
 +
####Minimizes risk of HIV and CMV infection
 +
###Irradiated
 +
####Eliminates capacity of T-cells to proliferate (prevents graft-versus-host disease)
 +
####Consider in transplant pts, neonates and immunocompromised pts
 +
###Washed
 +
####Indicated for pts w/ hypersensitivity to plasma (such as IgA deficiency)
  
===Indications (by Hb)===
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===Indications===
#Normal (rarely if >10; almost always if <6)
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#Acute hemorrhage or chronic anemia with Hb <6
#Critically ill, otherwise healthy (keep > 7-9)
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#Symptomatic anemia or cardiopulmonary disease AND Hb <10
#Ischemic heart dz/critically ill age >65 (keep >10)
+
 
 +
===Dose===
 +
#One unit (250mL) raises hemoglobin by 1 g/dl
 +
##Usually transfuse at least 2 units at a time (15mL/kg in peds)
 +
#Must transfuse no slower than 1 unit/4hr
 +
##If require slower transfusion (e.g. risk for volume overload) the pRBC can be split
 +
 
 +
==Platelets==
 +
===Features===
 +
#Transfusion should be type specific b/c platelets are bathed in plasma
 +
##Non-type specific plts can be used but results in higher rate of complications
 +
#Like pRBCs, plts can be leukocyte reduced or washed
 +
 
 +
===Indications===
 +
#Plt count <10K in asymptomatic patients (unless due to ITP, TTP, or HIT)
 +
#Plt count <15K with a coagulation disorder or minor bleeding
 +
#Plt count <20K with major bleeding
 +
#Plt count <50K with need for invasive procedure or surgery
 +
#Plt count <100K with need for neurologic or cardiac surgery
  
==FFP==
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===Dose===
===Usual Dose===
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#1 unit raises count by 50K
#10-20 ml/kg (average adult = 3-6 units)
+
 
#2 U of FFP (450 mL) should correct most early coagulopathies
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==Fresh Frozen Plasma==
#An INR of 2.0 correlates w/ PT 1.5 times nl
+
===Features===
 +
#Contains all coagulation factors and fibrinogen
 +
##40 mL/kg raises any factor by 100% (each unit is ~200mL)
 +
#May cause fluid overload
 +
#ABO compatibilty a must but crossmatch before transfusing not
 +
#INR of FFP is ~1.2
  
 
===Indications===
 
===Indications===
# Active bleeding AND PT/PTT >1.5 times nl (INR >2.0)
+
#Rapid reversal of warfarin over-anticoagulation
# INR >20.0
+
#Bleeding and multiple coagulation defects
# Massive PRBC transfusion (>9 U)
+
#Correction of coagulation defects for which no specific factor is available
# DIC not corrected by cryo.
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#Transfusion of more than one blood volume w/ evidence of active bleeding + coagulopathy
# Coumadin overdose AND life threat bleed/invasive procedure
 
  
==Platelets==
+
===Dose===
===Usual Dose===
+
#Transfuse at least 15 mL/kg at a time (4 units in 70-kg adult)
#1 U per 10kg (~6-10 U) --> incr plat ~25,000.
+
 
#1 U (25-50 mL = "6-pack") --> incr plat 5-10,000 (adult) or 20,000 (20 kg child)
+
==Cryoprecipitate==
 +
===Features===
 +
#Cold insoluble protein fraction of FFP
 +
#Contains: fibrinogen, vWF, and factor VIII
 +
#1 bag (10ml) has 50-500 units of factor 8 activity
  
 
===Indications===
 
===Indications===
See "HEME: Thrombocytopenia
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#Bleeding with fibrinogen level of <100 milligrams/dL
 +
#Dysfibrinogenemia
 +
#Bleeding in vWD that is unresponsive to ddAVP and Factor VIII is unavailable
 +
 
 +
===Dose===
 +
#1 unit/5kg (usually 10 units are given at a time)
 +
##Each unit raises the fibrinogen level by 75)
  
==Risks==
+
==See Also==
#Hep B ~1:100,000
+
*[[Transfusion Reactions]]
#Hep C ~1:1 million
 
#HIV 1:2 million
 
  
==Source ==
+
==Source==
2/18/06 DONALDSON (addapted from Rosen, Lampe, Charfen)
+
Tintinalli
  
 +
[[Category:Drugs]]
 
[[Category:Heme/Onc]]
 
[[Category:Heme/Onc]]

Revision as of 05:27, 21 October 2011

Packed Red Blood Cells

Features

  1. Can give type O Rh-positive pRBCs to a man or woman no longer of child-bearing age
  2. Options:
      1. Leukocyte reduced
        1. Eliminates 70-85% of leukocytes
        2. Reduces nonhemolytic febrile reactions
        3. Prevents sensitization in pts who may require bone marrow transplant
        4. Minimizes risk of HIV and CMV infection
      2. Irradiated
        1. Eliminates capacity of T-cells to proliferate (prevents graft-versus-host disease)
        2. Consider in transplant pts, neonates and immunocompromised pts
      3. Washed
        1. Indicated for pts w/ hypersensitivity to plasma (such as IgA deficiency)

Indications

  1. Acute hemorrhage or chronic anemia with Hb <6
  2. Symptomatic anemia or cardiopulmonary disease AND Hb <10

Dose

  1. One unit (250mL) raises hemoglobin by 1 g/dl
    1. Usually transfuse at least 2 units at a time (15mL/kg in peds)
  2. Must transfuse no slower than 1 unit/4hr
    1. If require slower transfusion (e.g. risk for volume overload) the pRBC can be split

Platelets

Features

  1. Transfusion should be type specific b/c platelets are bathed in plasma
    1. Non-type specific plts can be used but results in higher rate of complications
  2. Like pRBCs, plts can be leukocyte reduced or washed

Indications

  1. Plt count <10K in asymptomatic patients (unless due to ITP, TTP, or HIT)
  2. Plt count <15K with a coagulation disorder or minor bleeding
  3. Plt count <20K with major bleeding
  4. Plt count <50K with need for invasive procedure or surgery
  5. Plt count <100K with need for neurologic or cardiac surgery

Dose

  1. 1 unit raises count by 50K

Fresh Frozen Plasma

Features

  1. Contains all coagulation factors and fibrinogen
    1. 40 mL/kg raises any factor by 100% (each unit is ~200mL)
  2. May cause fluid overload
  3. ABO compatibilty a must but crossmatch before transfusing not
  4. INR of FFP is ~1.2

Indications

  1. Rapid reversal of warfarin over-anticoagulation
  2. Bleeding and multiple coagulation defects
  3. Correction of coagulation defects for which no specific factor is available
  4. Transfusion of more than one blood volume w/ evidence of active bleeding + coagulopathy

Dose

  1. Transfuse at least 15 mL/kg at a time (4 units in 70-kg adult)

Cryoprecipitate

Features

  1. Cold insoluble protein fraction of FFP
  2. Contains: fibrinogen, vWF, and factor VIII
  3. 1 bag (10ml) has 50-500 units of factor 8 activity

Indications

  1. Bleeding with fibrinogen level of <100 milligrams/dL
  2. Dysfibrinogenemia
  3. Bleeding in vWD that is unresponsive to ddAVP and Factor VIII is unavailable

Dose

  1. 1 unit/5kg (usually 10 units are given at a time)
    1. Each unit raises the fibrinogen level by 75)

See Also

Source

Tintinalli