indications for red cells transfusion

Question 1

Indications for red cells transfusion

Answer 1

1. symptoms of anaemia
2. volume blood loss
3. cause of bleeding
4. cause of anaemia
5. cardiac dysfunction
6. atherosclerotic disease
7. bone marrow suppression
8. other

Question 2

Symptoms of anaemia

Answer 2

chest pain, dyspnoea (particularly on exertion) and dizziness.

Question 3

Volume blood loss

Answer 3

the rate and volume of the patient’s actual or anticipated blood loss should be measured and anticipated and used in the transfusion decision making process

Question 4

Cause of bleeding

Answer 4

acute or chronic causes of bleeding and potential for uncontrolled bleeding need to be assessed in the patient

Question 5

Cause of anaemia

Answer 5

Essential to adequately investigate cause of anaemia

Can identify treatable causes such as deficiency of iron or other haematinics

Question 6

Cardiac dysfunction

Answer 6

consider cardiac disease or dysfunction. Red cell transfusion may be associated with either reduced mortality or increased risk of adverse events dependent upon the degree of anaemia and the nature of the cardiac condition

Question 7

Atherosclerotic disease

Answer 7

Critical arterial stenosis such as coronary artery disease may modify the threshold of the use of red blood cells

Question 8

Bone marrow suppressio

Answer 8

Bone marrow suppression as a result of disease or treatment may effect the ability of the patient to replace lost red cells and may also be the cause of anaemia

Question 9

Hb concentration 70–100 g/L

Answer 9

Hb concentration 70–100 g/L
Within this haemoglobin (Hb) range, transfusion of red cells is not generally associated with a reduction in mortality. The decision to transfuse should be based upon the need to relieve clinical signs and symptoms of anaemia and the patient’s response to previous transfusions. In patients who are elderly or who have respiratory or cerebrovascular disease there is no evidence to warrant use of a different approach.2

Acute coronary syndrome (ACS) patients may benefit from transfusion if they have a Hb level less than 80 g/L.2 For ACS patients with a Hb concentration of 80–100 g/L, the effect of red cell transfusion on mortality is uncertain and may be associated with an increased risk of recurrence of myocardial infarction.2 Similarly, in the postoperative patient, in the absence of acute myocardial or cerebrovascular ischaemia, transfusion may be inappropriate where the Hb level is greater than 80 g/L.1 The decision to transfuse should be made with caution and only after careful consideration of the risks and benefits.2

In the critically ill patient group, where the most evidence is available, the consensus is that transfusion is generally not indicated when the patient’s Hb is greater than 90 g/L. There are no studies using this Hb level in the general medical or postoperative patient population.3

Question 10

Formula for dose in children

Answer 10

Transfusion
volume (ml)	=	Patient's
weight (kg)	x	(Desired
Hb (g/L)	–	Patient's
Hb (g/L) )	x	Transfusion
factor (0.5)