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NB: Hb (g/dL) ˜ Hct (%)/3.

See following table.

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Blood Products
RBCIndication for transfusion varies
  • Hct <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) × (HinitialHfinal)
  • 250 mL with 70% Hct
  • Each unit will increase Hct by ˜4%
  • Hypocalcemia (citrate)
  • Hyperkalemia
  • Thrombocytopenia
  • Hepatitis C
  • ABO incompatibility
  • Bacterial contamination, or endotoxin if donor septic
PlateletsPlatelet 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 otherwise
  • Fluid portion obtained from a single unit of whole blood that is frozen within 6 h of collection
  • Contains all plasma proteins including all clotting factors except platelets
  • Isolated factor deficiencies
  • Reversal of warfarin therapy
  • Correction of coagulopathy associated with liver disease
  • Massive blood transfusions and continued bleeding following platelet transfusion
  • Antithrombin III deficiency or thrombotic thrombocytopenic purpura (TTP)
Management of heparin resistance
  • Each unit increases level of clotting factors by 2–3% in adults
  • Initial therapeutic dose → 10–15 mL/kg
  • Goal = 30% of normal coagulation factor concentration
  • Same infectious risk as unit of whole blood
  • Sensitization to plasma proteins
  • ABO-compatible units should generally be given, but not mandatory
  • Warm to 37°C prior to transfusion
CryoprecipitatePortion of plasma that precipitates when FFP is thawed at 4°C
  • Hemophilia
  • vWF deficiency
  • Hypofibrinogenemia
80–100 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 antibodies
  • Infections
  • Allergic reactions
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Blood Products Pretreatment and Indications
  • Leukocyte-reduced
  • Most blood products are leukocyte-reduced since the 1990s
Filtering to reduce WBC from 1–2 billions to ˜5 millions in a unit of RBCsRBC, plateletsPrevention of
  • HLA immunization
  • Febrile nonhemolytic reactions
  • Immunosuppression
Decrease CMV transmission
PhenotypedCross-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 recipient
  • Severe congenital immunodeficiency syndromes
Intermediate-risk patients:
  • Premature infants undergoing exchange transfusions
  • Leukemia/lymphoma
  • Chemotherapy-induced bone marrow suppression
CMV-screenedBlood from donors who have been screened for CMV antibodiesRBC, platelets
  • Pregnant women
  • Premature infants born to CMV-seronegative mothers
  • CMV-seronegative recipients of allogeneic bone marrow transplants from CMV-seronegative donors
  • CMV-seronegative patients with acquired immunodeficiency syndrome

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