Indications for RBC transfusion
- Acute blood loss (loss of ~15% blood volume)
- anemia in patient with other cause of hypoxia
- anemia in patient with hx of heart disease
- patient with hgb less than 7-8
- symptomatic anemia
Steps after determining patient needs blood transfusion
- blood typing
- antibody screen
- cross match
antibody screening
Looking for antibodies against antigens on RBC that are already in patients serum
cross match
Testing donor and recipient blood types to ensure there will not be hemolytic event
packed RBC dosing
- one unit with raise adults hgb by 1g/dL
- children dosed based on weight
what happens if patient is given a unit and does not gain 1g/dL
most likely due to autonomic hemolytic anemia or mechanical hemolysis
How to decide if patient needs blood transfusion
- Iron panel
- EPO
- Vitals
- Check creatinine
Anemia and packed RBC
- RBC not indicated for all anemic patients
- patients with chronic anemia can receive ib hgb is less than 7
- patients with potentially correctable cause of anemia
platelet transfusion indications
- platelet count less than 10,000 in a non-bleeding patient
- patient with platelet type bleeding and platelets are under 20,000
- patient undergoing surgical procedure with platelet count less than 50,000
Why give patient platelets the day of surgery
- give platelets the morning of surgery, could sequester platelets if given day before, platelts also have shorter half life
- Platelet transfusion would only last about 7 days
Types of platelets available for transfusion
- pooled platelets: Platelets from 6 different donors- not enough platelets from any one of those donors
- apheresis platelets: Platelets all from one donor– blood is being taken out, platelets are centrifuged out, blood is put back into patient allowing for patient to donate more since RBC’s are being returned
How high would a 6 pack of platelets raise patients platelet count?
-30-50 K/uL
What is patient receives a unit of platelets and count only raises by 5k?
- Immune thrombotic cytopenic pupura
- Any disease causing platelet destruction
Situations where platelet transfusion might not be helpful
- Autoimmune platelet lysis (ITP) - will not get as high of rise as normal
- DIC: disseminated activation of coagulation system - would form clots all over body
- TTP: systemic activation of platelets- would form clots all over body
- Patient on aspirin: platelets will be useless in surgery- unless it was emergent
What does liver disease do to platelets?
- Liver forms lots of clotting factors
- Cirrhosis: can decrease platelet count and cause them to be abnormal
Risks of transfusion
○ Death: medical error- causing transfusion reaction; Hospitals now doing electric cross match, but problem is if patient is typed wrong will still have hemolytic event, Other problem would be hanging wrong bag of blood in room where two patients need transfusion
○ Infection (viruses, specifically HIV in 80’s); Bacterial contamination
-Transfusion reaction
Which product carries greatest risk of hemolytic transfusion
packed RBC
Which product carries the greatest risk of bacterial contamination
platelets bc they are stored at room temp
Which product has the largest delay from the time of order to the time of delivery to the patient
plasma bc it has to be thawed
Which produc is most difficult to keep in stock and why
platelets, only stored for 5 days
