Blood Transfusion

Blood Transfusion Reactions

  • Hemolytic reaction suspected:

    • Stop the transfusion, if an acute hemolytic reaction is suspected

    • increase IV fluids (caution in ESRD or CHF patient) and ensure 100 mL/hr urine output

    • check urine hemoglobin, if positive, add 2-amps of bicarbonate to IV fluids

    • send bags and patient's blood sample to the lab for testing, including cross match, Coomb's test, CBC, DIC panel, LDH, Haptoglobin, Total and Direct Bilirubin.

  • Anaphylactic sx:

    • In addition to above measure, give

    • IVF

    • Diphenydramine 50mg IVP X 1 and Tylenol 650 mg PO in mild reaction.

    • Add Hydrocortisone 100 mg IVP X 1

    • Epinephrine, 0.5 - 1 mL (1: 1000), IM

  • Volume overload sx:

    • Decrease rate of transfusion

    • Furosemide, 20 - 40 mg IV

  • sign transfusion reaction incident form

  • call your resident and the patient’s attending

Blood transfusion risks

  • Fever, chills, urticarial rash - 1:50 - 100 units

  • ABO incompat - 1:6000 units

  • HBV - 1:50,000-200,000 units

  • HCV - 1:100,00 units

  • HIV - 1:500,000 units

Blood Transfusion

  • PRBCs. 1 U of PRBC in an adult, will increase Hct approx. 3% and Hb by 1 g/dL

  • Indication: active bleeding, Hct <21%, Hct <24% in CAD, US, MI or cardiogenic shock; rapid blood loss >1.5L to 2L; not responding to resuscitation; autologous RBC; Hct <27%; Hct >24%; pt. is normovolemic but there is increased need for increased oxygen carrying capacity as indicated by: tachy and/or hypotension not corrected by adequate vol replacement. Mixed venous Hb-Oxygen sat. <65%; acute resp. failure of inadequate cardiac output or inadequate oxygenation. Oncology pt with bone marrow suppression.

  • PLATELETS. A single dose (adult: 1 apheresis of 6 concentrates; pediatric dose: 1 unit/10 Kg) will increase the platelet count by 25-35 K

  • FFP. A dose of 10 - 15 mL/L is usually adequate to correct a coagulopathy. 1 Unit contains approx. 225 ccs of plasma. A 70 Kg Pt requires 3 - 5 units of FFP.

  • CRYOPRECIPITATE. 1 unit of 10 Kg is usually adequate when cryoprecipitate is required. Indication: Fibrinogen <80 - 100 mg/dL or actively bleeding.

  • Prophylactic adm of 10 cc of 10% calcium gluconate is recomm. for every 500 ml of PRBC transfused - to prevent hypocalcemia

Fever and Blood Product Transfusions

  • For fever >100.5 deg F, first give Tylenol (assuming liver function normal)

  • have the temp checked again 30 minutes. If fever subsides, then begin transfusion and have vitals checked qProtocol.

  • If fever does not subside, then evaluate the patient.

Platelet transfusion threshold

  • bleeding pt with plt<50,000

  • CNS bleeding with plt<100,000

  • major surgery with plt<50,000

  • Asx pt withplt<10,000