Transfusion therapy resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]

Overview

• Blood transfusion
• Massive blood transfusion

Blood Products and Indications for Use

Blood Products	Indications	Dose
Packed red blood cells
Platelets
Fresh frozen plasma
Cryoprecipitate
Immunoglobulins
Albumin
Irradiated
Cytomegalovirus-negative
Leuko-reduced

Management

General Approach

Characterize the symptoms: ❑ Low red blood cell count or low hemoglobin level ❑ Difficulty concentrating ❑ Difficulty sleeping ❑ Dizziness ❑ Easy fatigability ❑ Headache ❑ Pale skin ❑ Rapid heart beat ❑ Shortness of breath ❑ Low white blood cell count ❑ Abnormal bleeding ❑ Fever ❑ Irritability ❑ Neurasthenia ❑ Recurrent infections - canker sores, gingivitis, periodontitis ❑ Low platelet count ❑ Blood in urine or stool ❑ Easy or excessive bruising ❑ Heavy menstrual flow ❑ Prolonged bleeding during surgery or after dental work ❑ Prolonged bleeding from cuts

Obtain a detailed history: ❑ Review medical records ❑ Past medical history ❑ Previous blood transfusion ❑ Cardiovascular disease ❑ Trauma ❑ Previous Surgery ❑ Infections e.g., HIV ❑ Malignancy ❑ Chronic kidney disease ❑ Medications - anticoagulants, thrombolytics -

Examine the patient: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Order laboratory tests: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Pre-transfusion preparation: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Low hemoglobin level

Coagulopathy

Low platelets

Coagulation factor deficiency

Indications

Indications

Indications

Consider fresh frozen plasma

Consider cryoprepitate

Consider prothrombin complex concentrate

Packed Red Blood Cells

Low hemoglobin concentration: ❑ ❑ ❑ ❑

Review indications to transfuse: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Actively bleeding: ❑ Frank bleeding ❑ ❑ ❑ ❑ ❑ Occult bleeding ❑ ❑ ❑ ❑ ❑

Yes

No

Asymtomatic

Symptomatic: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Symptomatic: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Asymptomatic

Treat

Transfuse packed red blood cells

Treat

Monitoring: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Manage complications: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

Treat underlying cause: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

References

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