Dosing and uses of RBCs (red blood cells)
Insufficient Tissue Oxygen Delivery Due to Active Bleeding / Symptomatic Anemia
1 unit increase hemoglobin 1 g/dL in average sized adults without active bleeding or hemolysis; usually given over 1-2 hours but not longer than 4 hours
Rarely necessary to transfuse to hemoglobin >10 g/dL
Actively bleeding patients dosing and rate of administration varies depending on rate of bleeding and must be evaluated on a case by case basis
Other Information
Usually blood loss >20% estimated total blood volume
Pediatric dosage forms and strengths
Insufficient Tissue Oxygen Delivery Due to Active Bleeding / Symptomatic Anemia
10-15 mL/kg increases hemoglobin 2-3 g/dL in patients without active bleeding or hemolysis
Actively bleeding patients dosing and rate of administration varies depending on rate of bleeding and must be evaluated on a case by case basis
Other Information
Usually blood loss >20% estimated total blood volume
RBCs (red blood cells) adverse (side) effects
Frequency not defined
Hemolytic Transfusion Reactions
Febrile Non-Hemolytic Reactions
Allergic Reactions ranging from urticaria to anaphylaxis
Septic Reactions
Transfusion Related Acute Lung Injury (TRALI)
Circulatory Overload
Transfusion Associated Graft Versus Host Disease
Postransfusion Purpura
Warnings
Contraindications
Should not be used to treat anemia that can be corrected with a non-transfusion therapy (e.g. iron therapy) unless immediate correction is urgently needed.
Not indicated solely to providing blood volume &/or oncotic pressure, a sense of well being, or to improve wound healing.
Cautions
If a transfusion reaction is suspected, the transfusion should be stopped, the patient assessed and stabilized, the blood bank notified, and a transfusion reaction investigation initiated. Massive or rapid transfusion may lead to arrhythmias, hypothermia, hyperkalemia, hypocalcemia, dyspnea, and/or heart failure.
All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters. No other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank.
Patient’s should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion.
Non-septic infectious risks include transmission of HIV (~1:2 mill), HCV (~1:1.5 mill), HBV (1:300k), HTLV, WNV, CMV, parvovirus B19, lyme disease, babesiosis, malaria, chaga’s disease, vCJD.
Iron overload in chronically transfused patients due to hemoglobinopathies or thalassemia.
Consult with blood bank medical director or hematologist if you have questions regarding special transfusion requirements.
Pregnancy and lactation
CMV-negative or CMV reduced risk (leukocyte reduced) RBCs should be used in pregnant women who are CMV-negative or whose CMV status is unknown.
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of RBCs (red blood cells)
Normal RBC lifespan is ~120 days.
Half-life of transfused RBCs is ~30 days in the absence of ongoing bleeding or hemolysis.
Each unit (~350-400mL) contains ~200-250mL of RBCs and thus ~200-250mg iron.
Mechanism of action
Increases blood oxygen carrying capacity.
Restores intravascular volume in acute active bleeding although it should not be used solely for this purpose.
Improves platelet function in patients with uremic bleeding.
