Indication of Blood Transfusion

Himal Pandey MBBS 2014 August, NMCTH

whom to give? Why to give? & what to give?

To restore the circulating blood volumeTo maintain Adequate oxygen delivery Replacement of clotting factors, and other

blood components

AIM

Transfusion triggerTransfusion trigger is defined as that value of

haemoglobin (Hb) below which RBC transfusion is indicated. 

History and present scenarioPerioperative RBC transfusion criteriaHb level (g/dl) Indications

<6 Likely to be benificial

6 to 8 Unlikely to be benificial in absence of bleeding or surgery

>8 No indication in absence of risk factors

Indications-----1. General indicationsAcute blood loss

Perioperative anemia- Preoperative, Intraoperative and Post operative

Severe burns

Infection(septicemia)

Chronic anemia

Hemorrhagic states/coagulation dysfunction

--2.Special indicationsMassive transfusion--indicated in severe trauma, ruptured aortic aneurysm &

other complication

Exchange transfusion-sickle cell anemia, thalassemia, neonatal polycythemia,

severe neonatal jaundice, in some drug toxicity

Autologous transfusion-aka itraoperative blood salvage

Acute blood loss% of blood loss Blood fraction

components< 20 % crystalloid

20 to 50 % Crystalloid + packed RBC

> 50 % Crystalloid + packed RBC+ albumin/Plasma

> 50 % , bleeding continues

Crystalloid + packed RBC+ albumin/Plasma+ FFP

Perioperative Transfusion

Severe Burn Criteria for transfusion-In child -In adult

Indication of different blood fractions for different condition

1.Whole blood-acute bllood loss with hypovolemia,exchange transfusion,

other means not available2.Packed red cells -in chronic anemias mainly in old age and in children to

minimise the cardiac overload due to transfusion- 1 unit increases the Hb level by 1g/dl3. FFP-in severe liver disease , congenital coagulation factor

deficiency, deficiency of clotting factors following warfarin therapy, DIC,massive transfusion

-1 unit increases clotting factors level by 3%

4.Cryoprecipitate-in deficiency of Factor VIII , fibrinogen and von willibrand

disease- Target is to make the plasma fibrinogen level 150 mg/dl5. Platelet concentrate-thrombocytopenia and drug induced haemorrhage(aspirin

and clopidogrel)-0.1 unt/kg when platelet drops below 20,000 or after

episodes of bleeding-one platelet concentrate can increase 10,000platelet/cc in

one hour6.Prothrombin complex concentrate-contains II,IX & X-in emrgency reversal of warfarin therapy7.Human albumin -burn, hypoalbuminemia and severe protein loss

Further Reading

-Bailey and Love’s SHORT PRACTICE OF SURGERY, 24th & 26th edition

-Schwarts Principle of Surgery,-Williams Hematology,-Harrison's Principles of Internal Medicine,18th edition-WHO Blood transfusion safety (Handbook)-https://www.transfusion.com.au-https://www.ncbi.nlm.nih.gov