Indications For Blood Products

Please document the indications for transfusion in the medical chart.

Red Blood Cells (Adults)

• Significant (>20% blood volume) blood loss
• Symptomatic* anemia with HgB < 7.0 g/dL
• Rapid onset or worsening anemia with symptoms or history of heart attack, stroke or lung disease.^†
• Sickle cell disease with end organ damage^‡ or to lower percent of sickle hemoglobin
• Chronic transfusion program (e.g., for sickle cell disease, Thalassemia)

*Tachycardia, postural changes, altered mentation, TIA, shortness of breath, chest pain, systolic BP < 100 mmHg
^† e.g. lung disease includes emphysema, COPD, pulmonary fibrosis, pulmonary hypertension
^‡ e.g. stroke, heart attack, acute chest syndrome or other complications

Red Blood Cells (Infants)

• Hct <20% with low reticulocyte count and symptoms of anemia*
• Hct <30% with an infant:
  • On <35% hood O₂
  • On O₂ by nasal cannula
  • On continuous positive airway pressure and/or intermittent mandatory ventilation with mechanical ventilation with mean airway pressure <6 cm H₂O
  • With significant apnea or bradycardia^†
  • With significant tachycardia or tachypnea^‡
  • With low weight gain^§
• Hct <35% with an infant:
  • On >35% hood O₂
  • On continuous positive airway pressure/intermittent mandatory ventilation with mean airway pressure >6–8 cm H₂O
• Hct <45% with an infant:
  • With congenital cyanotic heart disease

* Tachycardia, tachypnea, poor feeding.
^† More than six episodes in 12 hours or two episodes in 24 hours requiring bag and mask ventilation while receiving therapeutic doses of methylxanthines.
^‡ Heart rate >180 beats/min for 24 hours; respiratory rate >80 breaths/min for 24 hours.
^§ Gain of <10 g/day observed over 4 days while receiving > 100 kcal/kg/day.
Ref: Roseff, SD, Luban NLC, Manno CS. Transfusion 2002; 42:1398-413.

Plasma

• Active bleeding with a documented prolonged PT and/or APTT
• Invasive procedure† or surgery or documented bleeding with significantly prolonged PT/APTT* NOT due to Vit.K deficiency
• Massive bleeding in excess of normally anticipated losses
• Neonates with thrombocytopenia, prolonged PT/aPTT and increased D-dimers
• Immediate reversal of Warfarin (Coumadin)

* Significantly prolonged PT is > 19 .5 seconds and significantly prolonged aPTT >39.9 seconds for adults.
^† e.g. (lumbar puncture, central line, liver or renal bx, cardiac cath, interventional radiology procedure, endoscopy).

Platelets

• Prophylactically in a non-bleeding, nonsurgical patient with platelet count < 11,000/mm3 except for ITP and TTP
• Invasive procedure^† or surgery or documented bleeding AND a platelet count of < 50,000/mm3
• Invasive procedure† or surgery or documented bleeding AND documented platelet dysfunction (e.g., aspirin ingestion)*

^† e.g. (lumbar puncture, central line placement, liver or renal biopsy, cardiac catherization, interventional radiology procedure, endoscopy)
* Other causes of platelet dysfunction include medication such as Plavix, cardiopulmonary bypass and ECMO