Snapshot introduction RBCs, platelets, and coagulation factors (fresh frozen plasma [FFP], cryoprecipitate, factor concentrate) can be transfused Donated blood is separated into various components whole blood is centrifuged into RBCs and platelet-rich plasma platelet-rich plasma is further separated into platelets and plasma FFP is plasma frozen within 8 hours (in the United States) cryoprecipitate is FFP precipitate when thawed at low temperatures platelets can be selectively removed while returning rest of blood to donor via apheresis Blood products can be irradiated prevents proliferation of donor T-cells in recipients used for immunocompromised patients, first-degree relatives, HLA-matched products and intrauterine transfusions Blood products can be leukodepleted via filtration to attain CMV-negativity leukocytes contain CMV used for potential transplant recipients, neonates, AIDS patients, seronegative pregnant women Packed Red Blood Cells (pRBCs) Goal of pRBC transfusion is to increase oxygen carrying capacity 1 unit of pRBC should increase Hb by 1 g/dL or Hct by 3-4% Indications Hb < 7 g/dL login to view 2 more bullets higher Hb threshold (Hb < 10 g/dL) for patients with login to view 4 more bullets dilution of sickled Hb in sickle cell disease patients clinicical suspicion of blood loss - CBC will not demonstrate anemia in acute trauma "Type and Screen" (T&S) vs. "Type and Cross" (T&C) T&S determines blood group, Rh status, presence of major/minor autoantibodies T&C determines possible agglutination by mixing recipient and donor blood pRBC options in order of preference after T&S: crossmatched blood (not always available in emergencies) after T&C: donor blood of same group / Rh as recipient O negative blood for all females of reproductive age; O positive for all others Platelets (PLTs) Goal of PLT transfusion is to decrease risk of bleeding One unit of apheresis derived PLTs should increase PLT by ~50,000/uL Indications PLT < 10,000/uL for bleeding prophylaxis login to view 1 more bullet higher levels needed for therapeutic purposes login to view 2 more bullets patients with platelet dysfunction (or on antiplatelet agents) and active hemorrhage need PLT transfusion within normal range Relative contraindications thrombotic thrombocytopenic purpura heparin-induced thrombocytopenia post-transfusion purpura HELLP syndrome a/w preeclampsia Fresh Frozen Plasma (FFP) Goal of FFP transfusion is to decrease risk of bleeding due to coagulation factor deficiency Initial dosing at 10 mL/kg should raise factor levels by ~25% PT and/or PTT are checked 15 to 30 minutes after transfusion to adjust dose as needed Indications PT/PTT > 1.5x midpoint of normal in patients with following conditions, particularly if surgery is indicated and cannot be postponed: login to view 4 more bullets replacement of coagulatory factors in absence of specific concentrates Cryoprecipitate Goal of cryoprecipitate transfusion is to replace fibrinogen Contains fibrinogen, vWF, fVIII, fXIII, and fibronectin 1 unit of cryoprecipitate should increase fibrinogen level by 7-8 mg/dL 1 unit of FFP has equivalent of 2 units of cryoprecipitate, but at cost of higher volume Indications fibrinogen < 80-100 mg/dL in massive hemorrhage replacement of fVIII or vWF when fVIII concentrate or Humate (vWF/fVIII concentrate) is unavailable for fVIII deficiency and for von Willebrand disease Complications Most common adverse reactions to blood transfusion febrile nonhemolytic transfusion reaction login to view 14 more bullets transfusion related acute lung injury (TRALI) login to view 8 more bullets transfusion-associated circulatory overload (TACO) login to view 6 more bullets Most serious adverse reactions to blood transfusion acute hemolytic reaction login to view 4 more bullets dilutional pancytopenia login to view 1 more bullet bacterial contamination of blood Other effects minor blood group incompatibility login to view 3 more bullets citrate toxicity login to view 7 more bullets hyperkalemia login to view 1 more bullet coagulopathy login to view 1 more bullet