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% Clinical signs of anemia, such as Hct < 25% Irradiation is appropriate: - 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 .