OVERVIEW
- important indications
- doses
- blood product compatibilities
IMPORTANT INDICATIONS
Packed red blood cells (PRBCs)
- Hb<100 and high risk of myocardial ischemia
- severe anemia (e.g. Hb<70)
- major active bleeding and Hb<100
Platelets
- <10
- <20 and high risk (fever, neutropenia, antibiotics, risk of intra-cranial haemorrhage)
- <50 and active bleeding or requires invasive procedure
- <80 and requires neurosurgery or ophthalmic surgery
- platelet function defects and bleeding (regardless of platelet count)
FFP
- INR >1.5 and needs invasive procedure
- INR >1.5 and actively bleeding (e.g. massive transfusion protocol, post-bypass surgery)
Cryopreciptiate
- fibrinogen <1.0 and actively bleeding (e.g. massive transfusion protocol)
- DIC
- hereditary hypofibrinogenemia, haemophilia, von willebrand’s disease
Prothrombin complex concentrate (PCC)
- warfarin overdose (alternative to FFP)
Granulocyte concentrate
- neutropenic sepsis
IV immunoglobulin
- multiple — e.g. GBS, ITP, MG, vasculitits
Factor 7
- consider for rescue therapy if ongoing haemorrhage despite correction of pH and temeprature, blood products to correct coagulopathy and no clear surgical cause
DOSES IN PAEDIATRICS
- Red Cells: 4ml X kg X Hb g/dL rise required. (1 unit/bag ~ 300mL)
- Fresh frozen plasma: 10 – 20 ml/kg (1 bag ~ 230mL)
- Cryoprecipitate: 5-10 ml/kg (1 bag ~ 20mL)
- Platelets: 10ml/kg (1 unit ~ 60mL. 1 pooled bag = 5 units)
- Tranexamic acid: 100mg/kg then 10mg/kg/hr
- Factor 7: 90mcg/kg
- Prothrombin (factor 9) complex: 1mL/kg (25units/kg)
BLOOD PRODUCT COMPATIBILITIES
- For RBCs: O = universal donor; Â AB positive = universal acceptor
- For FFP: AB = universal donor
- RhD negative females of childbearing age should receive RhD negative products
- RhD negative male recipients and post-menopausal females may be transfused with RhD positive blood products with the exception of patients known to have anti-D or on regular transfusion support.
References and Links
- Anaestricks — Blood Product Doses
- RCH Melbourne CPG — Blood Product Transfusion
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