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BLOOD TRANSFUSION: INDICATIONS BY CLINICAL SETTING

Hospitalized and Critically Ill, But Hemodynamically Stable Without Coronary Artery Disease

  1. AABB 2016, NICE 2014, BCSH 2012: Use restrictive rather than liberal transfusion goals1

  2. AABB 2016

    1. Liberal Hg goal: >10 g/dL

    2. Restrictive Hg goal: >7 g/dL

Cardiac or Orthopedic Surgery Patients or Any Patient with Preexisting Cardiovascular Disease (AABB 2016)2

  1. Transfuse to Hg >8 g/dL

Patients with Acute Coronary Syndrome

  1. BCSH 2012, NICE 2014: Transfuse to Hg >8 g/dL

  2. AABB 2016: Insufficient evidence to recommend liberal or restrictive strategy

Critically Ill Patients with Sepsis (BCSH 2012)

  1. Transfuse to Hg >9–10 g/dL in early resuscitation

  2. Transfuse to Hg >7–9 g/dL in late resuscitation

Patients with TBI and Signs of Cerebral Ischemia (BCSH 2012)

  1. Transfuse to Hg >9 g/dL

Patient with Active GI Bleed (AABB 2016)

  1. No recommendation made

  2. Consider restrictive transfusion goal; improved 30-day mortality

  3. See Chapter 5, section “Upper GI Bleeding” for GI society recommendations.

Symptomatic Anemia3(AABB 2016)

  1. Transfuse for symptomatic anemia with hemoglobin below 10 g/dL

Sources:

  1. AABB 2016: Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage, JAMA. 2016;316(19):2025–2035. [http://jamanetwork.com/journals/jama/fullarticle/2569055]

  2. Effect of anemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348(9034):1055–1060. [https://www.ncbi.nlm.nih.gov/pubmed/8874456]

  3. BCSH 2012: Retter A, Wyncoll D, Pearse R, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. BJH. 2013;160(4):445–464. [https://www.ncbi.nlm.nih.gov/pubmed/23278459]

  4. NICE 2015: National Institute for Health and Care Excellence. Blood transfusion. NICE guideline. November 18, 2015. [https://NICE.org.uk/guidance/ng24]

1Insufficient evidence available to make blood transfusion recommendations regarding ACS, chronic thrombocytopenia, hematologic/oncologic disorders, and chronic transfusion-dependent anemia.

2Based on 1996 Lancet article cited in guidelines, defined as prior MI, history of angina, peripheral vascular disease, and congestive heart failure.

3Symptomatic anemia defined as chest pain, orthostatic hypotension, tachycardia not responsive to fluid resuscitation, and CHF.

PLATELET TRANSFUSION: INDICATIONS BY CLINICAL SETTING

Definitions

  1. 1 platelet unit = 1 apheresis unit = platelet concentrates from 4 to 6 units of pooled whole blood

Hospitalized Patients with Chemotherapy or Radiation-Induced Hypoproliferative Thrombocytopenia (AABB 2015)

  1. Transfuse of 1 unit prophylactically if morning serum platelets <10 × 109 cells/L

  2. No benefit known in giving more than 1 unit, or partial units

Minor Procedures in Patients with Thrombocytopenia (AABB 2015)

  1. Transfuse platelets prophylactically prior to procedure if serum platelets are below the following thresholds:

    1. Central venous catheter placement4: Platelets <20 × 109 cells/L

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