FOR EDUCATIONAL PURPOSES ONLY Red Cell Transfusion Guidelines These are guidelines only - each patient must be clinically Washington State Clinical Laboratory Advisory Council (CLAC) assessed for transfusion appropriateness. Originally Published: August 2003 Reviewed/Revised: July 2006/April 2009 ADULT Hematocrit (HCT)Values PEDIATRIC Hematocrit Values Less than 21% 21 - 27% Greater than 27% Less than 21% 21 - 27% Greater than 27% (Hemoglobin less than 7 g/dl) (Hemoglobin 7-9 g/dl) (Hemoglobin greater (Hemoglobin less than 7 g/dl) (Hemoglobin 7-9 g/dl) (Hemoglobin greater than 9 g/dl) than 9 g/dl) Transfusion Transfusion indicated if one or Transfusion Transfusion Transfusion indicated if one or Transfusion indicated more of the following: not indicated indicated more of the following: not indicated 1. Active bleeding 1. Active bleeding 2. Falling HCT (greater than 4% 2. Falling HCT (greater than decrease) within 24-hours 4% decrease) within 24- (assess if hemodiluted result) hours (assess if hemodiluted 3. History/risk for vascular, result) cerebral compromise, oncology 3. History/risk for vascular, diagnosis cerebral compromise, 4. In the setting of cardiac respiratory distress ischemia or infarct, consider 4. Prematurity with increased need for higher hemoglobin. apnea & bradycardia ACTIVE BLEEDING AUTOLOGOUS UNITS ADULTS Greater than 750 cc PEDIATRICS ADULTS PEDIATRICS estimated blood loss Loss of greater than 15% of Hematocrit less than 27% Hematocrit less than 21% the estimated blood volume (Hemoglobin less than 9 g/dl) (Hemoglobin less than 7 g/dl) Transfusion indicated Transfusion indicated Transfusion indicated Transfusion indicated References: 1. Herbert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care, N Eng J Med 1999 Feb 11; 340 (6): 409-17. 2. Goodnough LT, Anemia Transfusion and Mortality N Eng J Med 2001 OCT 25; 345:1272-1274. 3. Goodnough LT, Medical Progress Transfusion Medicine- First of two parts. N Eng J Med 1999 Feb 11;340:435-447. Goodnough LT, Medical Progress-Transfusion Medicine- Blood Conservation- Second of two parts. N Eng J Med 199 Feb 18; 340:525-533. 4. Swedish Medical Center (SMC) Blood Utilization Subcommittee; SMC Laboratory Committee, 2003. 5. Giancarlo Liumbruno, Francesco Bennardello, Angela Lattanzio, Pierluigi Piccoli, Gina Rossetti; Recommendations for the transfusion of red blood cells; Blood Transfus 2009; 7: 49-64. PUB #681-NonDOH.