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Calculate blood product requirements for red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. Estimate units needed based on current and target laboratory values.
• These calculations provide estimates only - actual response varies by patient
• Always follow institutional transfusion protocols and guidelines
• Obtain informed consent when possible before transfusion
• Reassess patient clinically and verify lab values after transfusion
• Consider risks vs benefits for each transfusion decision
• Blood bank consultation recommended for complex cases
| Product | Threshold | Clinical Context |
|---|---|---|
| RBC | < 7 g/dL | Stable hospitalized patients |
| < 8 g/dL | Cardiovascular disease, orthopedic surgery | |
| < 10 g/dL | Active bleeding, acute coronary syndrome | |
| Symptomatic | Any patient with symptomatic anemia | |
| Platelets | < 10,000/μL | Prophylactic in stable patients |
| < 50,000/μL | Before invasive procedures, active bleeding | |
| < 100,000/μL | CNS bleeding, neurosurgery, eye surgery | |
| FFP | INR > 1.5-2.0 | Active bleeding or before invasive procedures |
| Massive transfusion | 1:1:1 ratio with RBC and platelets | |
| Cryoprecipitate | < 100-150 mg/dL | Fibrinogen deficiency with bleeding |
| Product | Volume | Storage | Expected Effect |
|---|---|---|---|
| RBC (1 unit) | ~350 mL | 1-6°C, 42 days | Hgb ↑ 1 g/dL, Hct ↑ 3% |
| Platelets (1 unit) | ~50 mL | 20-24°C, 5 days | PLT ↑ 5,000-10,000/μL |
| Platelets (apheresis) | ~300 mL | 20-24°C, 5 days | Equivalent to 6 units |
| FFP (1 unit) | ~250 mL | -18°C, 1 year | Coagulation factors ↑ |
| Cryoprecipitate (1 unit) | ~15 mL | -18°C, 1 year | Fibrinogen ↑ 5-10 mg/dL |
Definition: Replacement of one blood volume in 24 hours, or > 50% in 3 hours.
Protocol Components:
Pre-transfusion Requirements:
Monitoring During Transfusion:
Acute Reactions (within 24 hours):
Delayed Reactions:
Pediatric Patients:
Cardiac Patients:
Jehovah's Witnesses:
Multiple studies show that restrictive transfusion strategies (lower hemoglobin thresholds) are associated with fewer complications, reduced mortality, shorter hospital stays, and decreased healthcare costs compared to liberal strategies. Blood transfusions carry risks including infections, transfusion reactions, immunomodulation, and iron overload. The TRICC trial established Hgb 7 g/dL as safe threshold for most hospitalized patients.
Activate MTP when you anticipate need for > 4 units of RBC in one hour, replacement of one blood volume in 24 hours, or clinical assessment suggests severe ongoing hemorrhage. Early activation improves outcomes in trauma and massive bleeding. Use ABC (Assessment of Blood Consumption) score or institutional criteria. Don't delay for laboratory confirmation in obvious hemorrhage scenarios. The 1:1:1 ratio prevents dilutional coagulopathy.
Type and screen determines the patient's ABO/Rh type and screens for antibodies (takes ~45 minutes). If no antibodies, compatible blood can be issued quickly. Crossmatch actually tests patient serum against donor red cells (takes ~60-90 minutes) and is more thorough. Use type and screen for elective surgeries with low bleeding risk. Use crossmatch for anticipated transfusion or antibody-positive patients. In emergencies, use O-negative (universal donor) blood immediately.
STOP the transfusion immediately, maintain IV access with normal saline, assess vital signs and patient status, notify blood bank and physician immediately, and save the blood product bag and tubing for investigation. Check for clerical errors first. Send post-transfusion blood sample (check for hemolysis), repeat type and screen, direct antiglobulin test, and urinalysis. Provide supportive care based on reaction type. Document everything thoroughly.
Platelets must be stored at room temperature (20-24°C) with constant agitation to maintain viability and function. This storage condition increases bacterial contamination risk, limiting shelf life to 5 days (with bacterial detection testing). Refrigeration or freezing damages platelet membranes and function. Research into cold-stored platelets and platelet preservation is ongoing. Always check expiration and inspect for clumping or discoloration before transfusion.
PCC contains concentrated vitamin K-dependent factors (II, VII, IX, X) and reverses warfarin much faster than FFP (minutes vs hours). It requires smaller volume (~50 mL vs 1000+ mL of FFP), reducing TACO risk. Use 4-factor PCC for warfarin reversal in major bleeding or before urgent surgery. Dose based on INR and weight. Consider in massive transfusion when FFP alone is insufficient. Drawback: risk of thrombosis, expensive.
Yes. Citrate in blood products (used as anticoagulant) chelates ionized calcium, causing hypocalcemia during rapid transfusion. Hypocalcemia impairs cardiac contractility and coagulation. Monitor ionized calcium levels during massive transfusion and supplement as needed (typically 1g calcium chloride or gluconate per 4-5 units of blood products). More critical in patients with liver disease (reduced citrate metabolism), hypothermia, or during rapid transfusion rates.
Alternatives include: 1) Autologous transfusion (preoperative donation, acute normovolemic hemodilution, cell salvage/autotransfusion), 2) Pharmacologic agents (EPO to boost RBC production, IV iron, tranexamic acid to reduce bleeding, desmopressin for platelet dysfunction), 3) Surgical techniques to minimize bleeding, 4) Accepting lower hemoglobin if patient stable, 5) Hemoglobin-based oxygen carriers (still experimental). These are especially important for Jehovah's Witnesses and patients with multiple antibodies.