Packed red blood cells
•
Maximum administration time: 4 hours.
•
Rate of infusion: Dependent on patient’s clinical condition.
•
Administration: Standard blood set for each unit hung, or Y-type set if blood is to be reconstituted.
•
Indications: Active bleeding with loss of ≥15% of total blood volume; anemia that is adversely influencing another medical disorder (e.g., unstable angina); symptomatic chronic anemia unrelated to nutritional deficiency.
•
Outcome measurement: Hemoglobin level within 24 hours.
Leucocyte-reduced red blood cells
•
Maximum administration time: 4 hours.
•
Rate of infusion: Dependent on patient’s clinical condition.
•
Administration: Standard blood set for each unit hung, plus a filter (filter not required if red blood cells are washed).
•
Indications: Clinically significant transfusion reactions; to reduce sensitization to histocompatibility antigens.
Frozen red blood cells (deglycerolized)
•
Volume: Approximately 200 mL.
•
Maximum administration time: 4 hours.
•
Rate of infusion: Dependent on patient’s clinical condition.
•
Administration: Standard blood set for each unit hung.
•
Indications: Storing of samples of rare blood groups and for autotransfusion.
•
Note: Use only in special situations.
Plasma
•
Volume: Approximately 200 mL.
•
Maximum administration time: 4 hours.
•
Rate of infusion: Dependent on patient’s clinical condition.
•
Administration: Standard blood set.
•
Indications: As a source of coagulation factors.
Frozen plasma is frozen within 24 hours of collection and contains higher levels of labile coagulation factors (V and VIII). Nonlabile factors are well maintained in both
frozen and
stored (banked) plasma. Plasma may be used for the following:
1.
Significant hemorrhage that results from a deficiency of coagulation factors
2.
Immediate hemostasis in a patient taking warfarin
3.
Abnormal clotting tests and active bleeding in a patient with severe liver disease or massive transfusion (whole blood volume replaced within 24 hours)
4.
Thrombotic thrombocytopenic purpura
5.
Prophylaxis before an invasive procedure associated with a significant bleeding risk
•
Outcome measurement: Prothrombin time (PT), activated partial thromboplastin time (aPTT), or both within 4 hours of transfusion.
Platelets
•
Volume: Approximately 50 mL.
•
Rate of infusion: As rapidly as tolerated by patient.
•
Administration: Blood component recipient set.
•
Indications: To improve hemostasis. Platelet use should be considered in the following situations:
1.
Patients with platelet counts of less than 20 × 10
9 on the basis of decreased platelet production
2.
Patients with consumptive thrombocytopenia (e.g., immune thrombocytopenia; disseminated intravascular coagulation [DIC]) only when bleeding is significant
3.
Patients with significant platelet dysfunction
•
Outcome measurement: Platelet count 1 hour after transfusion.
•
Note: Platelet transfusion reactions are common. In patients with a history of reactions, the use of acetaminophen, 650 mg orally, and diphenhydramine, 50 mg intravenously (IV), may prevent reactions. Narcotics (morphine, 5 to 10 mg IV) or steroids (hydrocortisone, 100 mg IV) also may be helpful. If these measures fail, leukocyte-reduced platelets are recommended.
In patients who are unresponsive to random donor platelets (defined by a <5-g/L increment in platelet count 1 hour after transfusion on two successive transfusions), platelets collected from a single donor by apheresis should be considered.
Cryoprecipitate
•
Rate of infusion: As rapidly as possible.
•
Administration: Blood component recipient set.
•
Indications: Cryoprecipitate contains significant amounts of factor VIII (100 U per unit of cryoprecipitate), fibrinogen (250 mg per unit of cryoprecipitate), and von Willebrand’s factor. It is therefore useful in the treatment of mild hemophilia A and von Willebrand’s disease and in the repletion of fibrinogen (e.g., DIC, dilutional coagulopathy). The dose is dependent on body mass, the indication for use, and the severity of the preexisting deficiency.
•
Outcome measurement: Factor VIII level and aPTT (hemophilia A); von Willebrand’s factor antigen level, bleeding time, or both (von Willebrand’s disease); fibrinogen level (DIC, dilutional coagulopathy)—all within 4 hours of transfusion.
Factor VIIa concentrate
•
Lyophilized, fractionated plasma product.
•
Specific activity and storage conditions stated on label.
•
Must be reconstituted before use.
•
Indications: Uncontrollable bleeding in hemophilia patients (with Factor VIII or IX deficiency) who have developed inhibitors against replacement factor VIII.
Factor VIII concentrate
•
Lyophilized, fractionated plasma product.
•
Specific activity and storage conditions stated on label.
•
Must be reconstituted before use.
•
Indications: Moderate to severe factor VIII deficiency and low titer of factor VIII inhibitors.
•
Note: Not for use in von Willebrand’s disease. Consult a hematologist before administration.
Factor IX complex
•
Lyophilized, fractionated plasma product.
•
Factor IX content and storage conditions stated on labels.
•
Must be reconstituted before use.
•
Indications: Factor IX deficiency. Consult a hematologist before administration.
Normal serum albumin
•
Concentrates of 25% in vials of 100 mL and 5% in vials of 250 and 500 mL.
•
Sodium content of approximately 145 mmol/L.
•
Indications: Hypoproteinemia with peripheral edema (give 25%); volume depletion when intravenous normal saline is contraindicated (give 5%).
Not indicated in an asymptomatic hypoproteinemic patient.