Pathology Clinical Services
Blood Bank Division

Guidelines for Transfusion of Blood and Blood Components

Note: When in doubt on the type and/or quantity of blood components necessary to treat a patient, telephone consultation with a Blood Bank Physician is readily available 24 hours a day by calling the Blood Bank at extension 772-1525.

  1. The subsequent conditions are considered to be reasonable indications for the use of the following blood component(s). Documentation in the medical record of clinical and laboratory response to transfusion of blood components is recommended (see individual blood components).
    1. Transfusion of Packed Red Blood Cells (PRBC). The Transfusion Committee generally supports the transfusion of red cells at a hemoglobin trigger of 7g/dL or hematocrit <21% in the asymptomatic normovolemic patient without significant risk factors or medical compromise. In individual patients, end-organ problems may warrant transfusion at a higher hemoglobin.

      The transfusion committee also recognizes the need for transfusion of red cells in the following conditions:

      1. Hemorrhagic shock due to:
        • Surgery
        • Trauma
        • Invasive procedure
        • Medical conditions (e.g., GI hemorrhage)
      2. Rapid active bleeding not responding to appropriate volume resuscitation or with hemodynamic compromise attributable to anemia.
      3. Hemoglobin <8 g/dL or hematocrit <24% with compromise in medical condition attributable to anemia, or hypovolemia when administration of crystalloids/colloids will be expected to result in a hemoglobin less than 7 g/dL
      4. Hemoglobin of 8-10 g/dL in high risk patients, such as those with:
        • CNS symptoms
        • Sepsis or sepsis like conditions with low peripheral vascular resistance
        • Pre-operative hemoglobin decreased to a level such that anticipated surgical blood loss would require certain intra operative transfusion

Note: One unit of packed red blood cells in an adult and 10 mL/kg in a pediatric patient will increase the hematocrit by approximately 3% and hemoglobin by 1g/dL in a normovolemic patient. Documentation of clinical and laboratory response to transfusion of PRBC is recommended within 24 hours after the transfusion is completed.

  1. Transfusion of Random Donor Platelets or Plateletapheresis Units. The Transfusion Committee generally supports the transfusion of platelets in the following conditions:
    1. Prophylactic Platelet Transfusions to prevent bleeding in the patient with Thrombocytopenia* and platelet count equal to or less than 10,000 per microliter blood.

      *Platelets are not to be transfused when thrombocytopenia is due to platelet destruction (e.g. antibody mediated thrombocytopenia such as ITP or drug induced, TTP, HUS, HELLP syndrome, etc), unless the patient has life threatening bleeding not treatable by other means.

    2. Platelet transfusions MAY be given to patients who have platelet counts equal to or less than 20,000 per microliter blood AND have bleeding due to thrombocytopenia or from pharmacologic or pathologic platelet dysfunction.

    3. Platelet transfusions MAY be given to patients who have platelet counts equal to or less than 50,000 per microliter blood AND active hemorrhage or have a potential for bleeding from an invasive procedure such as surgery, placement of a subclavian venous access, lumbar spinal puncture, etc.
    4. Platelet transfusions MAY be given to patients who have platelet counts equal to or less than 100,000 per microliter blood AND intracranial hemorrhage, neurosurgical procedures or ophthalmic surgical procedures.
    5. Platelet count greater than 100,000 and evidence of bleeding due to platelet dysfunction not responsive to DDAVP or cryoprecipitate (consultation with a Hematologist and/or a Blood Bank Physician is mandatory).

    Note: A single dose of platelets (adult: 6 unit pool or one pheresis unit; pediatric: 5-10 mL/kg) will usually increase the platelet count by 25K – 35K/microliter. Documentation of clinical and laboratory response to transfusion of platelets is recommended within 10-60 minutes after the transfusion is completed.

  1. Transfusion of Fresh Frozen Plasma
    1. Dilutional coagulopathy (i.e. massive transfusion), active bleeding, surgery or invasive procedure and at least one of the following:
      • Prothrombin Time (PT) greater than 20 seconds
      • Activated Partial Thromboplastin Time (aPTT) greater than 57 seconds
      • Specific clotting factor deficiency (≤ 25% of normal) for which other safer replacement product is not available.
    2. The Transfusion committee does not support the use of plasma to reverse the anticoagulant effects of Coumadin.

    Note: A dose of 10-15 mL/kg is usually adequate to correct a coagulopathy (1 unit of FFP = 250 mL). Documentation of clinical and laboratory response to transfusion of fresh frozen plasma is recommended within 1 hour after the transfusion is completed.

  2. Transfusion of Cryoprecipitate. The Transfusion Committee supports the transfusion of cryoprecipitate for:
    • Bleeding and/or potential for bleeding associated with surgery or in an invasive procedure and Fibrinogen levels less than 100 mg/dL
    • Fibrinogen levels less than 150 mg/dL with active hemorrhage or in patients with acute promyelocytic leukemia
    • Factor XIII deficiency (less than 25% of normal)
    • Platelet count greater than 100,000 with evidence of platelet dysfunction and no response to DDAVP

    Note: A dose of one unit per 10 kg is usually adequate when cryoprecipitate is required. Documentation of clinical and laboratory response to transfusion of cryoprecipitate is recommended within 1 hour after the transfusion is completed.

  1. Documentation and notification of the Blood Bank are required for the following:
    1. Any Suspected Transfusion Reaction:
      Fever, chills, hypertension, hypotension, apprehension, pain at site of infusion, tachycardia, nausea, vomiting, headache, backache, urticaria, rash, breathing difficulties, or a change in the color of the urine (i.e. red)

    2. Adverse Outcome From Transfusion
      Heart failure, pulmonary edema, acquisition of blood-borne disease from transfusion

Note: When in doubt on the type and/or quantity of blood components necessary to treat your patient, telephone consultation with a Blood Bank Physician is readily available 24 hours a day by calling the Blood Bank at 772-1525.

Revised and approved by the UTMB Transfusion Committee on May 30, 2013

Approved by the UTMB Medical Staff Executive Committee on June 13, 2013

Editorial edits approved by UTMB Medical Staff Committee on October 10, 2013