Transfusion


Facts
  • 1 Unit Platelet = 5000/microL
  • 1 Unit PRBC = 1 g/dg Hgb
    • The threshold for transfusion of RBC should be a hgb < 7 g/dL in adults and most children
    • What is normal Hgb level ?
      • African-Americans: Hgb tend to be 1 g/dL lower compared to the other U.S. ethnic groups studied.
      • Living at higher altitudes:
        • +1 g/dL at 1000 meters
        • Up to +5.5 g/dL at 5000 meters.
      • Smoking:
        • increases hemoglobin levels by 3 g/dL for a 1 pack/day smoker
        • +7 g/dL for individuals smoking more than 2 packs/day.
      • Pregnancy: results in a 1.0 - 1.5 g/dL reduction in normal hemoglobin levels.
  • EPO = Increase HCT 4-6% in 4-6 weeks
 

 
Transfusion orders In ICU: 
PRBC:
  • Tylenol 1g PO/PR, Benedryl 50 mg IV, Pepcid 20 mg IV, prior to transfusion.
  • Transfuse over 1-4 hours/unit depending on CV status
  • Appropriate transfusions:
    • < 7 medical (not ACS)
    • Other compelling "soft reasons" : < 8
    • ACS : < 9
    • Septic Shock: < 9 (if ScVO2 LOW)
    • Pre-op transfusion for at risk patients
    • <10 Trauma, Neuro, or Symptomatic anemia

 

Platelets:
  • < 5000
  • Bleeding: 500 - 30k
  • Need Surgery/invasive procedure: <50
 

 
Pre-Transfusion meds:
Benadryl 25mg 1 po x 1
PLUS
Tylenol 650mg 1-2 tabs po x 1