Virginia Commonwealth Univeristy

Practicing Excellence in Transfusion Therapy

VCUHS Transfusion Guidelines

Blood samples

Revised July 2006

Blood product

Dose

Response

Utilization guidelines

Packed RBC

Adult dose: 1 unit

Neonatal dose: 5-15ml/kg
  • 1 g/dl increase Hb
  • 3% increase in Hct
  • Hb < 8g/dl
  • Need to increase O2 carrying capacity
  • Blood loss > 30%

Platelets

Adult dose: 3x10¹¹ plts
Pool random donors (RDP)
v. single donor pheresis SD
Neonatal dose: 10 ml/kg
  • Increase in count
  • 30 – 60,000/µL/dose
  • Assay 10 min. – 1 hr. post transfusion
  • Plt < 10 – 20,000/µL
  • Plt < 50,000/µL with bleeding or invasive procedure
  • Plt < 100,000 CNS surgery
  • Platelet dysfunction with bleeding

Fresh frozen plasma (FFP)
or
thawed plasma
Warfarin reversal

5 – 8 ml/kg

Factor replacement

Adult dose: 2 – 4 units
Neonatal dose: 10 – 15 ml/kg

  • Decrease in PT, INR
  • Replace coagulation factors

 
  • PT > 1.5 x the upper limit of normal or the midpoint of normal range; aPTT > 1.5 x the upper limit of normal with bleeding or invasive procedure
  • Factor deficiency ONLY if no concentrate available

Cryoprecipitate

Adults: typical dose 10 units
Neonatal dose: 1 unit/10kg

 
  • Increase in fibrinogen
  • Increase vWF  (von Willebrand’s factor)
  • Increase factor VIII
  • Increase factor XIII
  • Fibrinogen < 100mg/dL
  • Von Willebrand’s Disease if other safer products not available
  • Uremic platelet dysfunction with bleeding

 

Risk/unit by serology: HBV 1: 208-488,000 HTLV I/II 1: 641,000
Risk/unit by Nucleic Acid Testing and serology combined ~HCV 1:1,600,000  ~HIV 1:1,900,000
Risk of West Nile Virus varies by year, location and season; testing by NAT

 

CMV seronegative components

Reduce exposure to cytomegalovirus (CMV)
Donor serum screened for CMV antibodies
Determine patient CMV immune status – order titer

Indications

  • CMV seronegative BMT and PBSC transplant candidates and recipients
  • Infants < 4 months of age
  • Intrauterine transfusions
  • Congenital immunodeficiencies
  • CMV seronegative children receiving CMV seronegative solid organ transplants
  • HIV positive patients who are also CMV seronegative
  • Seronegative pregnant women

Alternative = Leukoreduced components

Considered CMV “safe” equivalent

White cells which harbor CMV are removed

 

Sickledex negative red cells

Prevent the transfusion of abnormal Hgb S

Indications

  • Neonates < 4 months
  • Patients with sickle cell disease

Premedication: acetaminophen/benadryl caution
Premedication should be given only when indicated, not as a routine for all patients. Premedication may mask symptoms such as fever which is the first indication of an acute hemolytic transfusion reaction.

Informed transfusion consent
  • Obtained by MD, DO, PA, NP; witnessed
  • Complete form: check “I do” v. “I do not” consent
  • Required for RBC, FFP, Cryo, Platelets
  • Permit adequate lead time for special donations
  • Autologous donations
  • Patient selected donations (PSD) – family/friends
  • Caution: form includes option “I do not consent”

(Jehovah’s witnesses)

  For more information, please call Transfusion Medicine at (804) 828-0256.