Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ NB: Hb (g/dL) ˜ Hct (%)/3. ++ See following table. ++Table Graphic Jump Location|Download (.pdf)|PrintBlood ProductsProductDefinitionIndicationBenefitsRisksRBCIndication for transfusion variesHct <21 for ASA 1 or 2, Hct <31 for anyone with documented or suspected cardiac pathology (e.g., elderly) (controversial)In OR, often clinical judgment (labs take time, and Hct will not drop right away with acute bleeding) Allowable blood loss (ABL): weight (kg) × EBV (70 mL/kg for males, 65 mL/kg for females) × (Hinitial − Hfinal)250 mL with 70% HctEach unit will increase Hct by ˜4%Hypocalcemia (citrate)HyperkalemiaThrombocytopeniaHepatitis CABO incompatibilityBacterial contamination, or endotoxin if donor septicPlateletsPlatelet count should be >100,000 with minimum required for surgery at 50,000Each “large” unit (6 individual units) increases platelets by 10,000Stored at 20–24°. Thus, greater risk of bacterial contamination. Any fever in 6 h of transfusion is platelet-induced sepsis unless proven otherwiseFFPFluid portion obtained from a single unit of whole blood that is frozen within 6 h of collectionContains all plasma proteins including all clotting factors except plateletsIsolated factor deficienciesReversal of warfarin therapyCorrection of coagulopathy associated with liver diseaseMassive blood transfusions and continued bleeding following platelet transfusionAntithrombin III deficiency or thrombotic thrombocytopenic purpura (TTP) Management of heparin resistanceEach unit increases level of clotting factors by 2–3% in adultsInitial therapeutic dose → 10–15 mL/kgGoal = 30% of normal coagulation factor concentrationSame infectious risk as unit of whole bloodSensitization to plasma proteinsABO-compatible units should generally be given, but not mandatoryWarm to 37°C prior to transfusionCryoprecipitatePortion of plasma that precipitates when FFP is thawed at 4°CHemophiliavWF deficiencyHypofibrinogenemia80–100 U of factor VIII, 100–250 mg of fibrinogen, 50–60 mg of fibronectin, 40–70% of normal vWF levels, and anti-A and anti-B antibodiesInfectionsAllergic reactions++Table Graphic Jump Location|Download (.pdf)|PrintBlood Products Pretreatment and IndicationsTypeDefinitionProductsIndicationsLeukocyte-reducedMost blood products are leukocyte-reduced since the 1990sFiltering to reduce WBC from 1–2 billions to ˜5 millions in a unit of RBCsRBC, plateletsPrevention ofHLA immunizationFebrile nonhemolytic reactionsImmunosuppression Decrease CMV transmissionPhenotypedCross-matched for antigens other than ABO and RhesusRBC, plateletsPatients on chronic transfusion therapy (sickle cell disease, thalassemia, etc.)IrradiatedGamma irradiation of cellular components (lymphocytes) that reduce their ability to cause GVHD in immunocompromised recipientsRBC, platelets (decreases survival of viable platelets)High-risk patients: Bone marrow transplant recipientSevere congenital immunodeficiency syndromes Intermediate-risk patients: Premature infants undergoing exchange transfusionsLeukemia/lymphomaChemotherapy-induced bone marrow suppressionCMV-screenedBlood from donors who have been screened for CMV antibodiesRBC, plateletsPregnant womenPremature infants born to CMV-seronegative mothersCMV-seronegative recipients of allogeneic bone marrow transplants from CMV-seronegative donorsCMV-seronegative patients with acquired immunodeficiency syndrome++Table Graphic Jump Location... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.