indications for blood transfusion Flashcards
45 yr old woman
fatigue
menorrhagia x yrs
Hemoglobin 70 g/L
transfuse?
No
transfuse at < 70
signs and symptoms of anemia
- pallor
- fatigue
- dizziness, presyncope
SOB
chest pain
Hb content of 1 unit of packed RBCs
40g
One RBC unit raises Hb by
10 g/L (4L blood person)
75 yr old cardiac disease, MDS chest pain x2 weeks Hb 75 transfuse?
YES -
use a lower threshold if ischemic heart disease present
transfuse one unit at a time and reassess symptoms
80-90
Volume of packed red blood cell unit
~ 280mL
How do you transfuse red cells?
one unit over 2 hours and not more than 4
furosemide for patients with impaired cardiac function
Transfusion order
- transfuse 1 unit over 3 hours for patient with dyspnea and Hb 65
- lasix 20mg IV 30 mins pre-transfusion
55M gum bleed and petechiae
platelet 7 x 109
blasts on film
platelet transfusion?
Yes - no ITP suspected
- Transfuse 1 dose of platelets over 1 hour for Plt 7 and AML
Lasix 20mg iv 30 min pre-transfusion
Who should not get a platelet transfusion
anyone with
TTP
HIT
ITP
when should you transfuse?
platelets < 10 x 109 to prevent spotnaneous bleed except in ITP (treat with steroids)
should you transfuse if platelets are < 50
- transfuse to prevent major bleed/procedural/surgical
45M cirrhosis
tense ascites
INR elevated = 1.7
do you transfuse plasma?
no,
should be ok with paracentesis
will not see a change in INR
half life of a unit of FFP
1 unit of FP = ? mL
6-8 hrs in the nonbleeding patient
250 mL
15mL/kg dose of FFP = 3-4 units
increases clotting factors by
15-20%
when do you transfuse plasma?
major bleed or procedure with INR> 1.5
not for lines, throracentesis, paracentesis
microvascular bleeding, massive transfusion
universal plasma is
AB
plasma transfusion order
transfuse 4 units of plasma over 4 hours for an INR 2.5 and bleed
65M
warfarin
ICH
INR = 6
transfuse PCCs 3000 units for immediate reversal of warfarin for life threatening bleed
give vitamin K IV 10 mg for prolonged reversal
which are the vitamin K dependent factors
10 2 7 9
protein C and protein S
33 F G2P1
post partum hemorrhage
Fibrinogen 0.9g/L
do you transfuse cryoprecipitate?
tranfuse 10 units of CPT over 30 mins for a fibrinogen of 0.9g/L and bleeding
typical dose of CPT =
10 units
increases fibrinogen by 0.5g/L per 10 units
when do you order a Cryo?
- fibrinogen < 1g/L to treat microvascular bleed
- fibrinogen < 1.5-2 to treat life-threatening hemorrhage
