- important indications
- blood product compatibilities
Packed red blood cells (PRBCs)
- Hb <100 and high risk of myocardial ischemia
- severe anemia (e.g. Hb<70)
- major active bleeding and Hb<100
- <20 and high risk (fever, neutropenia, antibiotics, risk of intracranial haemorrhage)
- <50 and active bleeding or requires invasive procedure
- <80 and requires neurosurgery or ophthalmic surgery
- platelet function defects and bleeding (regardless of platelet count)
- INR >1.5 and needs invasive procedure
- INR >1.5 and actively bleeding (e.g. massive transfusion protocol, post-bypass surgery)
- fibrinogen <1.0 and actively bleeding (e.g. massive transfusion protocol)
- hereditary hypofibrinogenemia, haemophilia, von Willebrand disease
Prothrombin complex concentrate (PCC)
- warfarin overdose (alternative to FFP)
- neutropenic sepsis
- multiple — e.g. GBS, ITP, MG, vasculitis
- consider for rescue therapy if ongoing haemorrhage despite correction of pH and temperature, blood products to correct coagulopathy and no clear surgical cause
DOSES IN PAEDIATRICS
- Red Cells: 4ml X kg X Hb g/dL rise required. (1 unit/bag ~ 300mL)
- Fresh frozen plasma: 10 – 20 ml/kg (1 bag ~ 230mL)
- Cryoprecipitate: 5-10 ml/kg (1 bag ~ 20mL)
- Platelets: 10ml/kg (1 unit ~ 60mL. 1 pooled bag = 5 units)
- Tranexamic acid: 100mg/kg then 10mg/kg/hr
- Factor 7: 90mcg/kg
- Prothrombin (factor 9) complex: 1mL/kg (25units/kg)
BLOOD PRODUCT COMPATIBILITIES
- For RBCs: O = universal donor; AB positive = universal acceptor
- For FFP: AB = universal donor
- RhD negative females of childbearing age should receive RhD negative products
- RhD negative male recipients and post-menopausal females may be transfused with RhD positive blood products with the exception of patients known to have anti-D or on regular transfusion support.
References and Links
- RCH Melbourne CPG — Blood Product Transfusion
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.