Blood Products

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;  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