Transfusion: When & How Much

Blood, Clots & Transfusion · ICU Decoded chapter 46 · Free in full

Cited to AABB 2023.

Key points

Stay restrictive: transfuse at Hb 70 g/L (80 cardiac/ACS); platelets <10 for prophylaxis, <50 when bleeding; plasma treats bleeding/procedures, never volume.
Give cryoprecipitate when fibrinogen is <1.5 g/L; LP is safe at platelets ≥40×10⁹/L in stable patients.
Stop the transfusion for reactions: TRALI (ARDS picture, supportive) vs TACO (diurese) vs hemolytic (fluids, DIC watch).
Massive transfusion brings hypocalcemia from citrate, hyperkalemia, and hypothermia; monitor and replete.

Pathways

Managing an Acute Hemolytic Reaction

Fever, tachycardia, dyspnea, back pain, hemodynamic instability during/after transfusion → acute hemolysis suspected
STOP INFUSION IMMEDIATELY
General ABCs · O₂ and cardiac monitoring · recheck the patient name and typing · send blood and tubing to the Blood Bank
IV FLUIDS: isotonic crystalloid (NS/LR) to keep UOP >30–50 mL/hr; routine bicarbonate is not indicated
MEDICATIONS by reaction type: antipyretic for fever · antihistamine for urticaria · epinephrine 0.5 mg IM (not SC) only for anaphylaxis; routine steroids are not indicated
LABORATORY TESTS: CBC · Coombs test · haptoglobin · urine free hemoglobin · PT/PTT · bilirubin · fibrinogen · LDH

← Coagulopathy & the Bleeding Patient · The Clotting Patient →

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