Blood Transfusion

Aka: Blood Transfusion, pRBC, Packed Red Blood Cells, Red Blood Cell Transfusion, Autologous Blood Transfusion, Autotransfusion, Transfusion of Packed Red Blood Cells

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