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They must be ABO compatible with the recipient see Table 2. Clinical indications for red cell transfusion are discussed in Chapters 7 to In red cells in additive solution Table 3.
Irradiated red cells are indicated for patients at risk of transfusion-associated graft-versus-host disease TA-GvHD — see Chapter 8. The component must be irradiated by gamma or X-rays within 14 days of donation and it then has a shelf life of 14 days from irradiation. Indicated for patients with recurrent or severe allergic or febrile reactions to red cells, and severely IgA-deficient patients with anti-IgA antibodies for whom red cells from an IgA- deficient donor are not available see Chapter 5.
Platelet transfusion is indicated for the treatment or prevention of bleeding in patients with a low platelet count thrombocytopenia or platelet dysfunction. Platelets have ABO antigens on their surface and may have reduced survival if transfused to an ABO-incompatible recipient, although this is not usually clinically significant.
They are usually only available in groups O, A or B, with only a small number of group AB platelets produced. Group O platelets should ideally only be given to group O recipients. Selection of platelets for patients of other ABO groups is summarised in Table 3. RhD negative platelet concentrates should be given to RhD negative patients where possible, especially to RhD negative women of child-bearing potential.
When RhD-incompatible platelets have to be given, administration of anti-D immunoglobulin may prevent immunisation. The recent introduction of automated bacterial screening has allowed some Blood Services to extend the shelf life from 5 to 7 days after donation. They retain their normal shelf life. This component is indicated for patients with recurrent severe allergic or febrile reactions to standard platelet transfusions. The shelf life is reduced to 24 hours after preparation and they must be ordered specially from the Blood Service.
Some platelets are lost in the washing process and the component still contains around 10 mL residual plasma. Indicated for patients refractory to random platelet components because of the development of HLA antibodies after previous transfusions see Chapter 9.
Plasma is obtained from whole blood donations or component donation by apheresis. The UK Departments of Health recommend that patients born on or after 1 January should only receive plasma sourced from countries with a low risk of vCJD. Imported plasma is treated with a pathogen reduction process, such as methylene blue or solvent detergent treatment, to reduce the risk of viral transmission. Plasma components of the same ABO group should be transfused to patients wherever possible.
If ABO-identical plasma is not available, the selection criteria given in Table 2. Plasma components do not need to be matched for RhD group as they contain no red cells or red cell stroma. Plasma is frozen soon after collection to maintain the activity of blood-clotting factors. Standard UK FFP is issued as single-donor packs which must be thawed before use, usually in a purpose-designed waterbath. Clotting factor levels vary widely between normal healthy donors and this variability is reflected in the concentrations found in individual packs of FFP.
FFP see Table 3. It may also be used in patients with inherited clotting factor deficiencies e. Transfusion-associated circulatory overload is the result of a rapid transfusion of a blood volume that is more than what the recipient's circulatory system can handle.
It is not associated with an antibody-mediated reaction. Those at highest risk are recipients with underlying cardiopulmonary compromise, renal failure, or chronic anemia, and infants or older patients. Cardiomegaly and pulmonary edema are often seen on chest radiography. The diagnosis is made clinically, but may be assisted by measuring brain natriuretic peptide levels, which are elevated in response to an increase in filling pressure.
Transfusion-associated graft-versus-host disease is a consequence of a donor's lymphocytes proliferating and causing an immune attack against the recipient's tissues and organs.
It is fatal in more than 90 percent of cases. Risk factors include a history of fludarabine Oforta treatment, Hodgkin disease, stem cell transplant, intensive chemotherapy, intrauterine transfusion, or erythroblastosis fetalis. Other probable risk factors include a history of solid tumors treated with cytotoxic drugs, transfusion in premature infants, and recipient-donor pairs from homogenous populations.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. LISA N. Reprints are not available from the authors. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med. Transfusion strategies for patients in pediatric intensive care units. King KE, Bandarenko N. Bethesda, Md. Red blood cell transfusion in clinical practice.
Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets.
Toward rational fresh frozen plasma transfusion: the effect of plasma transfusion on coagulation test results. Am J Clin Pathol. Recommendations for the transfusion of plasma and platelets.
Blood Transfus. Guidelines for the use of platelet transfusions. Br J Haematol. Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. Platelets, frozen plasma, and cryoprecipitate: what is the clinical evidence for their use in the neonatal intensive care unit? Semin Perinatol. Slichter SJ. Platelet transfusion therapy. Hematol Oncol Clin North Am. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia.
Cryoprecipitate: the current state of knowledge. Transfus Med Rev. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Investigation of whether the acute hemolysis associated with Rh o D immune globulin intravenous human administration for treatment of immune thrombocytopenic purpura is consistent with the acute hemolytic transfusion reaction model. Lichtiger B, Perry-Thornton E.
Hemolytic transfusion reactions in oncology patients: experience in a large cancer center. Incidence of allergic reactions with fresh frozen plasma or cryo-supernatant plasma in the treatment of thrombotic thrombocytopenic purpura. J Clin Apher. Transfusion reactions associated with anti-IgA antibodies: report of four cases and review of the literature. Transfusion-related acute lung injury and transfusion-associated circulatory overload: mutually exclusive or coexisting entities?
Vox Sang. Stack G, Tormey CA. The association of cytokine gene polymorphisms with febrile non-hemolytic transfusion reaction in multitransfused patients. Transfus Med. Universal leukoreduction decreases the incidence of febrile nonhemolytic transfusion reactions to RBCs. Popovsky MA. Transfusion-associated circulatory overload: the plot thickens. Use of B-natriuretic peptide as a diagnostic marker in the differential diagnosis of transfusion-associated circulatory overload. Webb I, Anderson KC.
In: Anderson KC, ed. Philadelphia, Pa. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Next: Diabetic Nephropathy: Preventing Progression. Mar 15, Issue. A 1 , 2 , 6 RCTs in adults and children with a critical illness A restrictive transfusion strategy hemoglobin level of 7 to 9 g per dL [70 to 90 g per L] should not be used in preterm infants or children with cyanotic heart disease, severe hypoxemia, active blood loss, or hemodynamic instability.
B 2 RCT in children with a critical illness Transfusion of plasma should be considered in a patient who has an International Normalized Ratio greater than 1. C 8 Consensus conference recommendations Platelets should not be transfused in patients with thrombotic thrombocytopenic purpura or heparin-induced thrombocytopenia unless a life-threatening hemorrhage has occurred. Enlarge Print Table 1. Some are quite rude, too.
Many are oncology patients. I am only trying to be safe and not dump in fluids too fast. It can take a long time if they are getting 3 units. Just curious if I am being over-protective??? That's my usual tendency, by the way not always a bad thing.
Apr 8, I usually run it over 3 hours. Take it easy on the elderly and frail. Those people your talking about can either be patient, or they can just go to "the clinic" everytime they need blood. You are right on the money! Transfusions are nothing to take lightly. Has 21 years experience.
I am a bit paranoid about running blood. I don't go above unless they are young and healthy. Then I go to It usually takes me 3. Not really a problem though since it is night shift that I work and the patients aren't in a hurry to go anywhere at that time. Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience. A lot depended on the patient's age, weight, and general healthI'd transfuse a unit in a younger patient with few other medical problems over 2 hours, while a unit going a frail elderly pt.
I was also very anal about staying with the patient for those first 15 minutes or soI caught more than one transfusion reaction that way, and was able to stop it before things got out of hand. Specializes in Inpatient Acute Rehab.
It depends on the situation.
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