Blood products
Packed Red Blood Cells
Features
- 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)
- Leukocyte reduced
Indications
- Acute hemorrhage or chronic anemia with Hb <6
- Symptomatic anemia or cardiopulmonary disease AND Hb <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
Dose
- 1 unit raises count by 50K
Fresh Frozen Plasma
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
- Rapid reversal of warfarin over-anticoagulation
- Bleeding and multiple coagulation defects
- Correction of coagulation defects for which no specific factor is available
- Transfusion of more than one blood volume w/ evidence of active bleeding + coagulopathy
Dose
- Transfuse at least 15 mL/kg at a time (4 units in 70-kg adult)
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
- 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)
- Will raise fibrinogen level by 75
See Also
Source
Tintinalli