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) (Documentation of clinical and laboratory response to transfusion of PRBC is recommended within 24 hours after the transfusion is completed)

      1. Hemorrhagic shock due to:
         • Surgery
         • Trauma
         • Invasive procedure
         • Medical conditions (e.g., GI hemorrhage)
      2. Active bleeding with:
         • Blood loss in excess of 20% of the patient’s calculated blood volume, or
         • Blood loss with 20% decrease in blood pressure and/or 20% increase in heart rate
      3. Symptomatic anemia with
         • Hemoglobin less than 8 g/dL
         • Angina pectoris or CNS symptoms with hemoglobin less than 10 g/dL
      4. Asymptomatic anemia
         • Preoperative hemoglobin less than 8 g/dL, AND
         • Anticipated surgical blood loss greater than 500 mL

Note: In individual patients, end-organ problems may warrant transfusion at a higher hemoglobin. Consultation with a Hematologist and/or a Blood Bank Physician is recommended.

2. Transfusion of random donor Platelets or Plateletapheresis units (Documentation of clinical and laboratory response to transfusion of platelets is recommended within 10-60 minutes after the transfusion is completed)

   1. Prophylactic Platelet Transfusions (to prevent bleeding in the patient with Thrombocytopenia).*

      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 50,000 per microliter blood AND have bleeding due to thrombocytopenia* or platelet dysfunction.

      * Patients who have intracranial hemorrhage MAY be given platelet transfusions to maintain the platelet count at 100,000 per microliter blood. 

   3. Platelet transfusions MAY be given to patients who have platelet counts equal to or less than 50,000 per microliter blood AND have a potential for bleeding from an invasive procedure such as surgery, placement of a subclavian venous access, lumbar spinal puncture, etc.* # 

      * Patients who have central nervous system or ophthalmic surgical procedures MAY be given platelet transfusions to maintain the platelet count at 100,000 per microliter blood. 

      # Platelet transfusions ARE NOT to be given to patients solely for prophylaxis before having a bone marrow biopsy or aspiration.

   4. 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)

3. Transfusion of Fresh Frozen Plasma  (Documentation of clinical and laboratory response to transfusion of fresh frozen plasma is recommended within 1 hour after the transfusion is completed)

   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 18 seconds (1.5 times the mid range of normal at UTMB)

      • Activated Partial Thromboplastin Time (aPTT) greater than 54 seconds (1.5 times the upper range of normal at UTMB)
      • Specific clotting factor deficiency(< 25% of normal) for which other safer replacement product is not available.

4. Transfusion of Cryoprecipitate (Documentation of clinical and laboratory response to transfusion of cryoprecipitate is recommended within 1hour after the transfusion is completed)

   1. Bleeding and/or potential for bleeding associated with surgery or an invasive procedure and at least one of the following:
      • Fibrinogen levels less than 115 mg/dL
      • Factor XIII deficiency (less than 25% of normal)
      • Platelet count greater than 100,000 with evidence of platelet dysfunction and no response to DDAVP

2. The following categories are not considered indications for platelet transfusion (Consultation with a Hematologist and/or a Blood Bank Physician is recommended)

   1. ITP (Immune/Idiopathic Thrombocytopenic Purpura)
   2. TTP/HUS (Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome)
   3. HELLP Syndrome (Hemolysis, Elevated Liver enzymes and Low Platelet count) in a pregnant or post partum woman
   4. Hypersplenism

3. 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 extension 772-1525.

Revised and approved by the UTMB Transfusion Committee on August 26, 2004
Approved by the UTMB Medical Staff Executive Committee on September 9, 2004