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Blood Transfusion
Aka: Blood Transfusion, pRBC, Packed Red Blood Cells, Red Blood Cell Transfusion, Autologous Blood Transfusion, Autotransfusion, Transfusion of Packed Red Blood Cells
- See Also
- Transfusion Complication (Transfusion Reaction)
- Transfusion Hemolysis
- Blood Product
- Massive Blood Transfusion
- Hemorrhage Management
- Definitions
- Autologous Blood Transfusion (Autotransfusion)
- Blood Product transfusion in which the recipient is also the donor, and receives their own Blood Products
- Recipient may donate their blood in preparation for major surgery in which large blood loss is expected
- Hemothorax may also be drained, filtered and re-transfused (e.g. Hemovac or Cell Saver)
- Red Blood Cell Transfusion
- Donor erythrocytes (Red Blood Cells) are processed, filtered, tested and reinfused into a recipient
- Preparations
- Packed Red Blood Cells are derived from whole blood by removing 250 ml plasma
- Remaining product contains 200-250 ml per unit pRBC
- Most centers filter Leukocytes before storage
- Decreases Febrile Nonhemolytic Transfusion Reaction risk
- CMV-safe
- Precautions
- Transfused Red Blood Cell lifespan is 50-60 days at best (significantly shorter than the 120 lifespan of a native RBC)
- Without Iron Replacement and intact RBC synthetic function, expect Hemoglobin to drop again within weeks
- Treat the underlying cause of chronic Anemia in hemodynamically stable, relatively asymptomatic patients
- Erythropoietin is preferred in Anemia due to Chronic Renal Failure, Chemotherapy
- Iron Replacement is preferred in chronic Iron Deficiency Anemia (e.g. chronic Menorrhagia)
- Indications
- Acute Sickle Cell Crisis (CVA Prevention)
- Massive acute blood loss >1500 ml (30% of Blood Volume)
- Hemorrhagic Shock
- Hemoglobin <7.0 g/dl and no serious comorbidity (and no ongoing bleeding)
- Hemoglobin <9.0 g/dl with serious comorbidity (e.g. cardiovascular disease, active bleeding)
- Symptomatic Anemia
- Severe Fatigue, weakness, or Dizziness
- Dyspnea
- Altered Level of Consciousness
- Angina
- Congestive Heart Failure
- Hospitalized patient criteria (per American Association of Blood Banks)
- Hemoglobin <7 mg/dl if hemodynamically stable (even if critically ill)
- Hemoglobin <8 mg/dl if orthopedic surgery, cardiac surgery or preexisting Coronary Artery Disease
- Unclear threshold for Acute Coronary Syndrome, severe Thrombocytopenia, chronic transfusion-dependent Anemia
- Dosing
- Massive Hemorrhage
- See Massive Hemorrhage for protocol
- Hemodynamically stable, non-bleeding patient
- Transfuse 1 unit pRBC at a time with reassessment of status between units
- Labs
- Hemoglobin
- Expect one unit pRBC to raise Hemoglobin by 1 g/dl
- Hematocrit
- Expect one unit pRBC to raise Hematocrit by 3%
- Adverse Effects
- See Transfusion Hemolysis (Immune Transfusion Reaction)
- See Transfusion Complication
- References
- Klein (2007) Lancet 370(9585): 415-26 [PubMed]
- Raval (2020) Am Fam Physician 102(1):30-8 [PubMed]
- Sharma (2011) Am Fam Physician 83(6): 719-24 [PubMed]