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
