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