Blood Transfusion

Aka: Blood Transfusion, pRBC, Packed Red Blood Cells

1. See Also
   1. Transfusion Complication
   2. Transfusion Hemolysis
2. Preparations
   1. Packed Red Blood Cells are derived from whole blood by removing 250 ml plasma
   2. Most centers filter Leukocytes before storage
      1. Decreases febrile nonhemolytic transfusion reaction risk
      2. CMV-safe
3. Indications
   1. Acute Sickle Cell Crisis (CVA Prevention)
   2. Massive acute blood loss >1500 ml (30% of Blood Volume)
   3. Hemoglobin <7.0 g/dl and no serious comorbidity (and no ongoing bleeding)
   4. Hemoglobin <9.0 g/dl with serious comorbidity (e.g. cardiovascular disease, active bleeding)
   5. Symptomatic Anemia
      1. Severe Fatigue, weakness, or Dizziness
      2. Dyspnea
      3. Altered Level of Consciousness
      4. Angina
      5. Congestive Heart Failure
   6. 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
4. 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%
5. Adverse Effects
   1. See Transfusion Hemolysis (Immune Transfusion Reaction)
   2. See Transfusion Complication
6. References
   1. Klein (2007) Lancet 370(9585): 415-26 [PubMed]
   2. Sharma (2011) Am Fam Physician 83(6): 719-24 [PubMed]