Table 8: Transfusion of Blood Components: Recommendations Based on Serial Laboratory values

Component Content Volume Expected Change in Labs Indication/Trigger

Goals of Transfusion

WarmFreshWhole Blood (WFWB)

Samecomponentsinsamepercentagesasblood

loss

400-500mL 1unitWFWBreplacesallcomponentsof blood loss in similar ratio without loss of individual component function from storage.

1unitWFWBincreasesHgbapproximately1g/dLorHctby3%.

Hgb<8.0g/dLinbleedingpatient.

If patient stable and not bleeding,Hgb<6.0g/dL;or Hgb<8.0g/dLandpatientissymptomatic.

Hgb10g/dL,orHct30%

Packedredblood cells (PRBCs)

Red blood cells, preservative and anticoagulant solutions may vary.

Hctofpackedcells:50%-65%;containsapproximately42.5-80gofhemoglobin;containsapprox147-278mgofiron.

128–240mLredbloodcells;pluscontainsaverage50mLdonorplasma(range20–150mL);plusanticoagulantandpreservative.

1unitPRBCincreasesHgbapproximately1g/dLorHctby3%(assumesptnotbleeding or hemolyzing).

Hgb<8.0g/dLinbleedingpatient. If patient stable and not bleeding,Hgb<6.0g/dL;or Hgb<8.0g/dLandpatientissymptomatic.

Hgb10g/dL,orHct30%

Platelets RandomDonorPlatelets(RDP)shouldcontain>5.5x1010plateletsin50mLplasma.Fourto10RDPsarepooledpriortotransfusion.

PlateletsApheresis–SingleDonorPlatelets(SDP)should contain >3.0x1011(averageis3.5-4.0x1011 perbag)in250mLplasma.

SDParereadyfortransfusion–nothawingneeded.

Platelets(RDP)-50mLplasmaxnumberofRDPinthe pool.

PlateletsApheresis(SDP)-250mLofplasma.

ForeachRDPgiven–increasecount7,000-10,000/mm3.

ForeachSDPapheresispackgiven–increasecount30,000-60,000/mm3

Platelets<50,000–70,000/mm3 in actively bleeding patients;<20,000/mm3 in unstable non-bleeding patients;and<10,000/mm3 in stable, non-bleeding patients.

>100,000/mm3 in active bleeding patients

Freshfrozenplasma(FFP)

Non-cellularportionofbloodthatisseparatedfromwholebloodandfrozen.Containsallcoagulationfactors. Dosingisbasedonpatientcurrentweight;orinuncontrolled bleeding, given as close as possible to a1:1PRBC:FFPratio.

Approximately200-250mLin one unit.

Apheresis-derived units may be400-600mL.

PT>1.5timesthemidrangeofnormal;aPTT>1.5timehighnormalrange;orfactorassaylessthan25%.

PT<1.5xcontrol;aPTT<1.5xcontrol;Fibrinogen>100

Cryo-precipitatedAntihemolytic Factor(AHF)

EachunitofcryoprecipitateAHF(Cryo)shouldcontainatleast80IUFactorVIII:C,and150mgoffibrinogenin5to20mLofplasma.CryoalsocontainsFactorVIII:VWF(vonWillebrandfactor),FactorXIIIandfibronectin.

5–20mLperunit;seelabelfor total number of units included.

Typicaldoseforstablehypo-fibrinogenemiaisoneunitper7–10kgofbodyweight;increasesfibrinogenlevelsby50mg/dLintheabsenceofbleedingorconsumption.

Inhemorrhage,Cryomaybegiveninincreaseddosesof1unit/5kgor2units/10kg;andrepeatedasneededtomaintainfibrinogenlevels>100mg/dL.

Fibrinogen<100mg/dL Fibrinogen>100mg/dL

mL-milliliter,Hgb-hemoglobin,g/dL–gramsperdeciliter,Hct–hematocrit,g–gram,mm3–millimetercubed,PT–prothrombintime,aPTT–activatedpartialthromboplastintime,IU–internationalunits,kg–kilogram,mg/dL–milligramsperdeciliter