Ordering Blood Plasma Transfusion Cryoprecipitate is most likely NOT appropriate:

 Order type and crossmatch if blood is to be given  Minimum effective adult dose is 2 units (~ 500 ml)  Patients with concurrent clotting factor deficiency and immediately or scheduled to be given within 3 days  Be aware of patient’s volume status, do not fluid hypofibrinoginemia (use FFP instead)  Order type and screen if blood may not be given; overload  Patients with von Willebrand disease or hemophilia A crossmatch can later be completed quickly if needed. (use factor concentrates instead, when available)  INR ≥ 1.6 ≈ PT > 5 sec above upper normal  A crossmatch is needed only for red cells; plasma and Plasma is most likely appropriate: Red blood cell transfusion (adult) platelet orders do not require a crossmatch, but do require two patient blood type determinations on  Bleeding or before most procedures INR ≥ 1.6  One unit will raise Hgb by approximately 1 g/dL record.  Interventional radiology exceptions:  Hgb 8 g/dL ≈ Hct 24%, Hgb 10 g/dL ≈ Hct 30% - Emergent arterial procedure INR > 2.0 Platelet transfusion (adult) RBCs are most likely appropriate:

- Central venous line INR > 2.0  Store only at room temperature, do not refrigerate or - Venous procedure INR > 3.0  72 hr before and after surgery Hgb < 8 g/dL place in coolers.  Significant bleeding in patients with DIC any INR  Chronic anemia if other therapy fails Hgb < 8 g/dL

 Each dose of platelets should raise count by ~30x109/L  Clinical symptoms of anemia Hgb < 10 g/dL Plasma is most likely NOT appropriate:  Massive blood loss any Hgb Platelets are most likely appropriate:  Stable patients with INR ≤ 1.5 (>750 cc or >15% blood volume)  Stable without bleeding < 10x109/L  For treatment of hypovolemia or hypoalbuminemia 9 RBCs are most likely NOT appropriate:  Hematopoietic stem cell transplant ≤ 20x10 /L  Correction of isolated prolonged PTT (usually due to 9 heparin or lupus anticoagulant)  Asymptomatic patients with Hgb > 8 g/dL  Before major procedures & up to 72 hr after < 50x10 /L  Interventional radiology exceptions:  To replace a single coagulation factor if concentrate is 9 Modified Red Blood Cell Units Elective arterial procedure < 70x10 /L available (i.e. hemophilia and von Willebrand Disease) 9  Orders for “fresh” or “washed” RBCs are appropriate in Non-vascular procedure < 70x10 /L Cryoprecipitate transfusion  Neurological or ophthalmological procedure very few patients (i.e. severe transfusion reactions or or bleeding < 100x109/L  Typical dose is one pooled-pack which should raise specific causes of potassium elevation)  Bleeding or pre-operative and any count fibrinogen 40-50 mg/dL  Orders will be considered on a case-by-case basis

- Documented reason for platelet dysfunction; or Cryoprecipitate is most likely appropriate: Leukoreduced Products - Abnormal platelet function by thromboelastograph  Isolated hypfobrinogenemia (≤100 mg/dL)  All standard blood products at this institution are pre- Platelets are most likely NOT appropriate: storage leukocyte reduced to decrease the incidence  Patients with dysfibrinogenemia  Patients with immune thrombocytopenic purpura (ITP),  Bleeding in uremic patients if DDAVP and estrogens of febrile nonhemolytic transfusion reactions and HLA thrombotic thrombocytopenic purpura (TTP) or fail to improve platelet function or are contraindicated alloimmunization. heparin-induced thrombocytopenia (HIT) unless they  As part of massive transfusion  Leukocyte reduced units are CMV-safe products with have life-threatening hemorrhage virtually equivalent risk of CMV transmission as CMV seronegative units.

CMV-negative Products

 For nearly all patients leukoreduced blood is Concise Blood equivalent to CMV-negative blood Supplementary Pediatric Guidelines

 CMV-negative blood is not routinely stocked RBCs are most likely appropriate: Product Ordering  Shock due to perinatal blood loss Blood Irradiation  Infants on mechanical ventilation with: And Administration  To prevent graft vs. host disease in susceptible MAP > 8 and FIO2 > 0.4 Hct < 35% patients FIO2 < 0.4 Hct < 28% Guidelines  Does not sterilize product or reduce risk of infection Recently extubated with FIO2 > 0.4 Hct < 28%

Irradiation is appropriate:  Clinical signs of anemia, such as Hct < 25% - Unexplained bradycardia or apnea for 48 hours  Hematologic malignancies - Serum lactate > 2.5 mEq/L  Hematopoietic stem cell transplant recipient or - Poor weight gain with adequate calories scheduled for HSC transplant - Unexplained lethargy  Receiving purine analogs (fludarabine, 2-CDA, etc.)  Prior to surgery Hct < 25% Blood Bank: 8-4444  HLA-matched products or directed donations from  Without signs of anemia Hct < 20% blood relatives Platelets are most likely appropriate:  Intrauterine transfusion Based on guidelines prepared by:  Preterm infants with increased risk < 50 x109/L  Newborns who received intrauterine transfusions or UCD Blood Utilization of bleeding are in the neonatal ICU Review Committee  Congenital T cell-mediated immunodeficiencies (DiGeorge’s, SCID, Wiskott-Aldrich, etc)

Irradiation is most likely NOT appropriate:

 Patients with AIDS or HIV

 Solid organ transplant recipients Complete guidelines available at: https://www.uchealth.org/professionals/Pages/Clinica  Patients receiving immunosuppressive therapy or chemotherapy who do not meet above criteria l-Laboratory/Transfusion-Services.aspx  Congenital humoral immunodeficiencies (aggamaglobulinemia, hypogammaglobulinemia)

Updated: April 2015