Transfusion

MTP Adult (≥15 yo, >50 kg)

MTP 9-14 yo (30-50 kg)

MTP 0-8 yo (< 30 kg)

 

PRBC

  • 325 ml per unit
  • 1 unit or 10 ml/kg raises by 1 g/dl

FFP

  • 250 ml
  • 1 unit or 20 ml/kg increases clotting by 20%

 

PLT

  • 1 unit = 250 ml
  • 1 unit or 4 ml/kg increases by 20-40K
  • May not need typing (does at HCMC)
  • Indications:
    • <5-10K
    • Invasive procedure <30K
    • Major surgery <50K
    • NSG or retinal surgery <70K

Cryo

  • 1 unit = 100 ml
  • 1 unit or 1 ml/kg increases fibrinogen by 25-50 mg/dl
  • Does not need typing
  • Indications:
    • Low fibrinogen, Hemophilia A, VWB, Factor XII or XIII (fibronectin) deficiency

Transfusion

  • Consent
  • Risks: HBV 1:200-500K; HCV and HIV 1:1-2 million
  • Irradiated: Hodgkin disease, congenital cellular immunodeficiency (SCID/DiGeorge), neonates w/ inherited immunodeficiency, BMT, people on fludarabine
  • Washed: PNH, Hx of febrile or anaphylactic transfusion reactions, IgA deficiency
  • If no access to leukoreduced PRBCs, consider CMV negative products for pregnant women and immunocompromised

MTP

  • Adult cycle (Starting at 15 yo)
    • 1 cycle = ~ 50% of blood volume
    • 4 u PRBC, 4 u FFP, 1U plt
  • Pediatric cycle 1m-8y (<30 kg)
    • PRBC 20 ml/kg to max 2u
    • FFP 20 ml/kg to max 2u
    • PLT 4 ml/kg to max 0.5u
  • Pediatric cycle 9y-14y (30-50 kg)
    • PRBC 2u
    • FFP 2u
    • PLT 0.5u
  • TXA
    • Load – 1 g (15 mg/kg)
    • Infusion – 125 mg/hr (2 mg/kg/hr) x 8 hrs
  • Cryprecipitate
    • Give for fibrinogen < 100 mg/dl
    • 4 ml/kg to increase level by 100-200 mg/dl
  • Ca++ and Mg++
  • Indications:
    • 4U or 20 ml/kg of PRBC in 1 hr
    • Transfusion volume of >50% in 12 hrs (3 hrs in peds)
    • Significant hemorrhage and coagulopathy (INR>1.5, fibrinogen <100, PLT <100)

Compatibility

Universal Donors:

  • PRBC – Oneg
  • PLT – Oneg
  • FFP – ABpos

 

Transfusion Reactions