🩸 Chapter 110: Blood Products & Transfusion Practices

PRBC (10-15 mL/kg raises Hb 2-3 g/dL) · Platelets (5-10 mL/kg) · FFP (10-15 mL/kg) · Cryoprecipitate · Transfusion thresholds · TRALI, TACO, transfusion reactions · Irradiated/washed products · Leucodepletion

🔍 Core Concepts: Blood Products & Transfusion

📌 PRBC (Packed Red Blood Cells)
10-15 mL/kg raises Hb by 2-3 g/dL. Threshold: Hb <5 g/dL (all), <7 g/dL (stable critically ill), >14 g/dL (cyanotic CHD post-op). Leucodepleted, irradiated for immunocompromised.
🩸 Platelets
1 unit/10 kg or 5-10 mL/kg raises count by 30-50k. Threshold: <10k (asymptomatic), <20k (fever/sepsis), <50k (invasive procedure), <100k (ECMO/neurosurgery).
💧 FFP (Fresh Frozen Plasma)
10-15 mL/kg. Indications: DIC with bleeding, warfarin reversal, liver disease, massive transfusion. Do not use for volume expansion.
🧪 Cryoprecipitate
Contains fibrinogen, factor VIII, vWF. Dose 1-2 units/10 kg. Indications: hypofibrinogenaemia (fibrinogen <100), DIC, haemophilia A, vWD.
⚠️ Transfusion Reactions
TRALI (ARDS within 6h), TACO (fluid overload), febrile non-haemolytic, anaphylaxis (IgA deficiency), haemolytic, bacterial contamination (platelets).
🔁 Special Products
Irradiated PRBC (prevent TA-GVHD): immunocompromised, HSCT. Washed PRBC: severe allergic reactions, IgA deficiency. Volume-reduced platelets: fluid overload.

🩺 Stepwise Approach: Blood Transfusion

1
Obtain consent & baseline labs
Informed consent, blood group/type, cross-match. For infants <4 months, use maternal sample for antibody screen.
2
Identify appropriate product & dose
PRBC: 10-15 mL/kg. Platelets: 5-10 mL/kg (or 1 unit/10 kg). FFP: 10-15 mL/kg. Cryoprecipitate: 1-2 units/10 kg.
3
Special modifications
Irradiated for immunocompromised/HSCT. Washed for IgA deficiency/severe reactions. Leucodepleted (standard). Volume-reduced platelets for fluid overload.
4
Administer & monitor
Use blood filter, infuse PRBC within 4h. Monitor vitals q15min x1h. Stop if reaction. Do not add medications to blood bag.
5
Recognise & manage reactions
Febrile: antipyretics, leucodepleted. Allergic: antihistamines (severe: stop, epinephrine). TRALI/TACO: supportive care, diuretics, ventilation. Haemolytic: stop transfusion, fluids, monitor renal function.
6
Document & report
Document reason, product, dose, tolerance. Report adverse reactions to blood bank. Maintain transfusion record.