- A T&S is good for 72 hours. If a patient has NEVER had one at Sinai before, send for 2 T&S on admission.
- Make sure you have the patient sign a Transfusion Consent Form.
- Premedicate with 650mg of tylenol and 25mg of PO Benadryl 30 minutes prior to transfusion.
- Give with 20mg IV Lasix if patient has CHF or other reasons for volume overload.
Transfusion Products and Indications
| Product | Indication | Appropriate Response | Run Over | Clinical Pearls |
|---|---|---|---|---|
| pRBCs | - Symptomatic Anemia - Usually with Hgb <7 |
1 unit pRBCs should increase Hgb by 1 | 3 hours (faster if clinically indicated) | - Treatment with large # pRBCs can decrease Ca++ and increase K+ - Use leukoreduced products to reduce risk of non-hemolytic transfusion reaction. |
| Platelets | - Prophlyaxis when plt < 10K. - Prophylaxis when plts < 20K if febrile. - Prophylaxis when plts < 50K prior to invasive procedure. - Active microvascular bleeding secondary to platelet dysfunction/thrombocytopenia. - Acquired or Intrinsic platelet dysfunction prior to an invasive procedure. |
A pool of 5-6 platelet concentrates or a single apheresis unit should increase platelets by 5-10K | 30-60 minutes | - Avoid in those with TTP b/c it can worsen neurological symptoms. - Avoid in those with HIT or DIC unless bleeding. - ~ 10% of platelets are replaced each day, so it is usually sufficient to d/c drugs like ASA/Plavix 5-7 days before surgery. |
| FFP | - Replacement of coagulation factors II, V, VII, IX, X, XI - Coumadin reversal with supratherapeutic INR and bleeding. |
Number of units varies depending on INR required. | 30 minutes | - Use of FFP in massive blood transfusion i.e. >4u pRBCs - The INR of FFP is ~1.6, so can't correct much below this. Can try vitamin K. |
| Cryoprecipitate | - DIC (when Fibrinogen <150), Hemophilia, vW disease | 1 bag raises fibrinogen by at least 30 mg/dl | 30 minutes | - Contains Factor VIII, fibrinogen, vWF, Factor XIII. - Normal Fibrinogen levels don't r/o DIC; you must trend them. |
Acute Hemolytic Reaction
Signs: Fever, Flank Pain, Hypotension, Hemoglobinuria, DIC, "Feeling of impending doom"
-
Management:
- Immediately stop the transfusion
- Send both the blood product and a sample of the patient’s blood to the lab for the following tests: T&C, Coomb's, CBC, DIC Panel (fibrinogen, haptoglobin, LDH), ** total Bilirubin, BMP.
- Hydrate with isotonic fluid (NS or Plasmalyte) to keep UOP > 100 ml/hr and MAP >65.
Severe, non-hemolytic reaction
Signs: Fever, Chills, Mild Dyspnea
-
Management:
- Immediately stop the transfusion
- Send both the blood product and a sample of the patient’s blood to the lab for the following tests: T&C, Coomb's, CBC, DIC Panel (fibrinogen, haptoglobin, LDH), ** total Bilirubin, BMP.
- Consider Benadryl 25-50 mg PO/IV, Hydrocortisone 50mg IV, epinephrine 0.5-1.0ml (1:1,000) IM.
SOB
- DDX: Transfusion Reaction vs. TRALI vs TACO
- Decrease rate of transfusion
- Consider Furosemide 20-40 mg IV if overload (and NOT TRALI) is suspected.
- Supportive care.