Ordering Time
If patient already has blood typed and screened, blood can be sent to
the OR within 10 minutes of request.
Important: True emergency (bleeding-out)
situations should be clearly communicated to the blood bank early so that
they can provide expedited support and uncrossmatched blood if necessary.
Storage
Must be kept in an ice bucket at all times.
Indicator dot changes color when blood warms above 8
degrees C. Blood is then discarded if not used.
Indications
Rarely indicated with Hb above 10, almost always
indicated with Hb below 6.
Allowable Pre-Transfusion Blood Loss: |
|
V = EBV x
Ho – Hf |
|
V = Volume to be removed or Blood Loss |
|
EBV = Estimated Blood Volume |
|
Ho = Initial Hct |
|
Hf = Desired Hct |
Hav = Average Hct (Average of Ho and Hf) |
|
EBV: |
|
Premature: 100 ml/kg |
|
Newborn: 80 ml/kg |
|
Adult Male: 70 ml/kg |
|
Adult Female: 65 ml/kg |
Dose/Efficacy
Adults:
1 unit increases Hb by 1 g/dL or Hct by 3-4 %
Pediatrics:
Transfusion of 8 ml/kg increases Hb by 1 g/dL
Recommendation
Type and screen patients but do not order blood units until you are
fairly certain you intend to transfuse. As long as the patient does not have
antibodies (a normal screen), you can get blood within 10 minutes.
Unused blood must be returned to Blood Bank if indicator dot
shows that blood has not warmed. Units should be kept in the cooler except
when in transit.
Note: Temperature indicators are not used on
split-units. Split-units will be discarded if not returned within 30 minutes.
RBC’s must be transfused within 4 hours of issue if not
kept in a cooler.
Ordering Time
Requires minimum of 40 minutes to thaw and label.
Available in 10 minutes if already thawed.
Storage
Store in OR at room temperature.
If left in the blood bank after thawing, FFP can be
used on any patient within 24 hours.
When FFP has been out of the blood bank for 30 minutes,
it cannot be re-cycled for another patient and is discarded.
Indications
PT or PTT ratio (test value/control value) should be at
least 1.5 before FFP is used.
No compatibility testing required, but ABO-compatible
FFP should be used. Therefore patient ABO-typing is required.
Dose/Efficacy
Volume of 1 unit is 200-250 ml. Usual adult dose is 4-6
units.
This will increase coagulation factors by 20 %
immediately.
Recommendations
Order FFP units to be thawed, but do not actually send
for any units until you are sure you intend to give them.
Leave any thawed but un-needed units in the blood bank
for re-cycling. (For example, you can ask for 6 units to be thawed and later
decide that you only need 2 units. If you leave the remaining 4 units in the
blood bank, they are available for any ABO-compatible patient for the next 24
hours.)
Ordering Time
Requires minimum of 40 minutes to thaw, pool, and
label.
Indications
A concentrated form of certain plasma proteins from FFP.
Indicated for fibrinogen, Factor VIII, and Factor XIII
deficiency only.
(von Willebrand’s disease patients unresponsive to desmopressin and bleeding
patients with fibrinogen levels below 80-100 mg/dL.)
No Factor V contained in cryoprecipitate.
Dose/Efficacy
Delivered as a pooled unit of 10 units.
Contains concentrated Factor VIII (von Willebrand
factor), fibrinogen, and Factor XIII.
Each unit increases fibrinogen in adults by 5 mg/dL.
Hemostatic fibrinogen level is > 100 mg/dL.
No compatibility testing, but ABO-compatible cryo
should be used when possible.
Recommendations
Order cryoprecipitate units to be thawed only when
definitely needed.
Pooled cryoprecipitate expires 4 hours after pooling.
Storage
Store in OR at room temperature
Never refrigerate- factors will precipitate out.
When cryoprecipitate has been out of the blood bank for
30 minutes, it cannot be re-cycled for another patient and is discarded.
Ordering Time
Available from blood bank within 10 minutes via tube
system.
Storage
Store in OR at room temperature
Never refrigerate- if cooled, platelets are
inactivated.
Indications
Usually indicated in surgical patients with platelet
counts below 50,000/mcl. Rarely indicated with platelet counts above 100,000/mcl.
No compatibility testing, but ABO-compatible platelets
should be used when possible.
Dose/Efficacy
Adult dose is 6 units of random platelets or 1 bag of
platelet pheresis pack
One dose increases platelet count in adults by 30-60,000/mcl.
Recommendations
Do not order until you are sure that you plan to
administer platelets. They will be discarded if returned to blood bank in
over 1 hour.
1. Practice Guidelines for Blood Component
Therapy: A Report by the American Society of Anesthesiologists Task Force on
Blood Component Therapy. Anesthesiology 1996: 84:732-47 (c) 1996
American Society of Anesthesiologists. Available on the Internet at: (http://www.asahq.org/Practice/Blood/Blood_Component.html)
2. Blood
Transfusion Therapy: A Physician’s Handbook. 5th Edition. American Association of Blood Banks, 1996.
3. Stehling L. and Zauder H.L., Acute normovolemic
hemodilution. Transfusion 31:9, pg. 857-868, 1991.
4. Goodnough LT et al, Transfusion Medicine. NEJM 340:6,
2 parts, 1999.
J. Kent Garman, M.D., M.S.
Stanford University Department of Anesthesia