BLOOD TRANSFUSION

Question 1

pRBC TRANSFUSION

Answer 1

INDICATIONS: NON-BLEEDING ADULT

Hgb < 60: 1-2 U Recommended

Hgb < 70: 1 U appropriate

Hgb < 80: 1 U appropriate in CAD

Hgb < 90: If signs and symptoms of impaired tissue oxygen delivery

INDICATIONS: BLEEDING ADULT
Low risk patient : maintain > 70 while actively bleeding

CAD patient: maintain > 80 while actively bleeding

INDICATIONS: PLATELET TRANSFUSION
1 platelet pool for:

<100: peri-neurosurgery, head trauma or CNS bleeding, extreme life threatening injury

<50: significant bleeding, major surgery, lumbar puncture, pre-invasice procedure a/w significant blood loss

<30: therapeutic anti-coagulant that can’t be stopped

<10: Non-immune & immune thrombocytopenia

<100: Antiplatelet agent and CNS bleeding

INDICATIONS: PLASMA TRANSFUSION
massive hemorrhage, microvascular bleeding: 2 Units per 4 units pRBC

Significant bleeding and INR > 1.8: 3-5 Units

INDICATIONS: CRYOPRECIPITATE
Extreme life threatening hemorrhage & fibrinogen < 2

Microvascular bleeding & fibrinogen < 1

COMPLICATIONS
Dilutional coagulopathy

Question 2

MASSIVE TRANSFUSION

Answer 2

TRIGGER
Anticipate the need for at least 4 U pRBC, & component therapy plt, Plasma, Fibrinogen

TRIGGER CRITERIA
Blood loss greater than 1500 mL or greater than 6 PC

Uncontrolled hemorrhage and hemodynamic instability

Ongoing bleeding after 4 PC

Trauma patients with ABC score greater or equal to 2

Resuscitation intensity of greater or equal to 4 units of fluid in first 30 min (fluid = 1 unit RBC, 1 unit plasma, 500 mL colloid, 1 L crystalloid)

TXA
2 g in 100 mL IV over 20 min via pump

TESTING
Baseline and q hourly:

CBC, INR, PTT, Fibrinogen, iCa, Lactate, Lytes, ABG

Ensure blood bank has group and screen

TRANSFUSION PROTOCOL
Pack 1: 4 pRBC

Pack 2: 4 pRBC and 4 Plasma

All subsequent packs: 4 pRBC and 2 plasma

Platelets and fibrinogen PRN based on lab results

Prepare 4 g of fibrinogen concentrate for all code obstetrics

TARGETS
Hgb > 80
Plt > 50
INR < 1.8
Fibrinogen > 1.5 (2 for obstetrics)
iCa >< 1.15
Base deficit < 3
SBP 70-90 mmHg unless TBI
No role for octaplex
Temperature: 36 - 37.5