Blood Usage Transfusion Indications

Red Blood Cells

ADULT
Average hematocrit of a unit of RBCs is 55 65%
1. Symptomatic anemia with Hgb <7 gm/dL (Hct <21%)
(hypotension, tachycardia, acidosis, EKG changes)
2. Coronary Syndrome with Hgb <9 gm/dL (Hct <27%)
3. Hematology/Oncology patients with hematopoietic dysfunction or bone marrow failure with
Hgb <9 gm/dL (Hct < 27%)
4. Profound hypovolemia/anemia with Hgb <8 gm/dL (Hct <24%) with evidence of
decreased oxygen delivery (e.g., decreased SvO2, decreased cardiac output/index)
5. Sepsis with Hgb <7 gm/dL (Hct <21%) or Hgb <7-10 gm/dL (Hct <21-30%) in elderly
patients or those with CAD
6. Bone Marrow Transplant Patients undergoing Total Body Irradiation with Hgb <10 gm/dL
(Hct <30%)
7. Actively bleeding
PREMATURE INFANTS
1. Hgb <9 gm/dL (Hct <28%) on room air with unexplained breathing disorder, tachycardia
(>180 bpm), poor growth (weight gain <10 gm/day), lethargy
2. Hgb <9 gm/dL (Hct <28%) requiring supplemental oxygen >40% FiO2
3. Hgb <12 gm/dL (Hct <36%) requiring respiratory support (vent, CPAP or high flow nasal
cannula > 2 L/M), hypotension with decreased capillary refill, requiring major surgery
4. Hgb <13 gm/dL (Hct <39%) with cyanotic heart disease, persistent pulmonary
hypertension of the newborn requiring nitric oxide or ECMO
5. Hypovolemic shock due to acute blood
TERM INFANT <4 MONTHS OF AGE
1. Hgb <7 gm/dL (Hct <21%)with clinical manifestation of anemia and low reticulocyte count
2. Hgb <10 gm/dL (Hct <30%) with acute surgical blood loss > 15% of the blood volume
3. Hgb <12 gm/dL (Hct <36%) with major surgery or respiratory support
4. Hgb <13 gm/dL (Hct <39%) with cyanotic heart disease, hypoxia or ECMO
5. Exchange transfusion for hemolysis or Hyperbilirubinemia

ALL CHILDREN > 4 MONTHS

1. Hgb <7 gm/dL (Hct <28%) chronic anemia not responsive to medical therapy
2. Hgb <7 gm/dL (Hct <28%) in patients receiving chemotherapy or irradiation
3. Hgb <10 gm/dL (Hct <30%) with acute surgical or potential blood loss greater than 15%
of the blood volume
4. Hgb <13 gm/dL (Hct <39%) with severe cardiopulmonary disease
5. Complications of SC disease (CVA or acute chest syndrome), chronic transfusion regimen
for thalassemia or other red cell disorders
6. Circuit prime for plasma exchange or stem cell collection

Platelets
Order as Adult Dose or number of units (up to 3 units) for pediatrics
Adult dose = approximately 3 x 1011 platelets, prepared
PROPHYLACTIC
1. )10,000/uL: Stable patient
2. )20,000/uL: Recent intracranial intervention or pathology, hyperleukocytosis, temp >38
C, coagulation abnormality, bladder cancer or necrotic tumor
3. )25,000/uL: Lumbar puncture
4. )30,000/uL: Neonates
5. )50,000/uL: Major surgery, central venous catheter placement, endoscopic biopsy, liver
biopsy, other invasive procedures
6. )100,000/uL: Intracranial or spinal cord or ophthalmologic surgery; DIC & ECMO patients
(pediatric patients)
7. Certain platelet function defect or anti-platelet drugs without contemporary results of
platelet functions prior to major surgery/invasive procedure
8. Outpatients with hematopoietic dysfunction or bone marrow failure who are likely to have
platelets <10,000/uL before then next CBC is drawn
Avoid, if clinically possible, prophylactic platelet transfusion if refractory to specially-selected
platelets
THERAPEUTIC
1. )50,000/uL: In presence of active bleeding during massive transfusion, cardiopulmonary
bypass, DIC, and massive transfusion
2. )100,000/uL: Suspected or evident intracranial, intraspinal or intraorbital bleeding
3. ECMO patients with bleeding
4. In presence of active bleeding and certain platelet function defects

Blood Bank Phone Extension 6-3951

Plasma
Published evidence regarding specific procedures consistently demonstrates that preprocedure
laboratory tests do not provide a reliable rationale for the use of preprocedure transfusion
therapies. The best decisions are made in the context of each patients full clinical pictures and
not on the basis of laboratory values alone.
1. Multiple clotting factor deficiencies, when the INR is > 1.7 in the following circumstances:



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2. Rapid reve rsal of warfarin effect in patients with active bleeding or imminent invasive
procedure
3. To correct congenital deficiencies of clotting factors
4. Thrombotic microangiopathies (TTP, HUS, HELLP syndrome)

Cryoprecipitate
For active bleeding or before invasive procedure/surgery in any of the following circumstances:
1. Fibrinogen levels <150 mg/dL
2. Uremic bleeding unresponsive to DDAVP
3. Dysfibrinogenemia (normal fibrinogen level)
4. Factor XIII deficiency
5. Von Willenbrand disease unresponsive to DDAVP and/or factor concentrate not available
6. Suspected or evident hemorrhagic stroke or intracranial bleeding in patients receiving
Tissue Plasminogen Activator (TPA)
7. Fibrinogen < 200 mg/dL prior to administration of recombinant Factor VIIa (NovoSeven)
All of the Indications for Transfusion are available in the Clinical Protocols section
of the EMR Home page under Blood Bank Parameters for Product Usage
http://emr.lumc.edu/ClinicalProtocol/Docs/Blood%20Bank%202008%20Practice%20
Parameters.pdf
Guidelines for Surgical Blood Usage are available in the Clinical Protocols section of the
EMR Home page under Blood Usage Guidelines for Surgery. Individual service guidelines
are also listed with the service section.
http://emr.lumc.edu/ClinicalProtocol/Docs/Blood%20Usage%20Guide%20for%20Surgery%20
MSBOS%20Revision%207-09.pdf

Blood Bank Phone Extension 6-3951

Specialty Blood Product Indications

CMV Negative
1. Seronegative Stem Cell Donor-Recipient Pairs / Recipient Candidates
2. Seronegative Oncology Diagnosis Receiving Chemotherapy
3. Seronegative Heart / Lung Transplant Recipients / Candidates
4. Seronegative Pregnant Woman
5. Very Low Birth Weight Infants (< 1500 grams)
6. Seronegative Patients Living w/ HIV / AIDS
7. All Intrauterine Transfusions

Irradiation
1. Stem Cell Transplant Recipients
2. Myelodysplastic Syndromes / Myeloproliferative Diseases
3. Leukemias / Lymphomas
4. Plasma Cell Dyscrasia
5. Bone Marrow Failure States
6. HLA Matched / Crossmatched Platelets and All Directed Donors
7. Congenital Cellular Immunodeficiency Syndromes (e.g., SCID, DiGeorge)
8. Pediatric Solid Tumors (e.g., Wilms Tumor, Neuroblastoma)
9. Very Low Birth Weight Infants (< 1500 grams)
10. Intrauterine Transfusions / Neonatal Exchange Transfusions / Neonatal ECMO

Leukocyte Reduction
Leukocyte Reduction is Achieved by Pre-Storage Component Production or Bedside Filtration
1. Chronic or Prolonged RBC or Platelet Transfusion Support
2. Stem Cell Transplant Candidates/Recipients
3. Bone Marrow Failure States
4. Leukemias/Lymphomas
5. Myelodysplastic Syndromes/Myeloproliferative Diseases
6. Sickle Cell Disease/Sickling Hemoglobinopathies/Thalassemia
7. Heart/Lung Transplant Recipients/Candidates
8. History of Repeated Febrile Non-Hemolytic Transfusion Reactions (FNHTR)
9. Cardio Thoracic surgical procedures with Median Sternotomy

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