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Chapter 238: Transfusion Therapy

Clinton J. Coil; Sally A. Santen

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    AMA Citation
    Coil CJ, Santen SA. Coil C.J., Santen S.A. Coil, Clinton J., and Sally A. Santen.Transfusion Therapy. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. Eds. Judith E. Tintinalli, et al.eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109386725. Accessed September 24, 2018.
    MLA Citation
    Coil CJ, Santen SA. Coil C.J., Santen S.A. Coil, Clinton J., and Sally A. Santen.. "Transfusion Therapy." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109386725.

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INTRODUCTION

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Modern transfusion practice uses blood that has been separated into specific components (Table 238-1). Coagulation factors, either derived from human plasma or manufactured with recombinant technology, are used treat hemorrhage associated with a deficiency of one or more factors (Table 238-2). Transfusion in the ED typically is done for acute blood loss and/or circulatory shock. As medical care is moved to outpatient settings, emergency physicians may be responsible for transfusion therapy or complications previously relegated to inpatient settings.1

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Table Graphic Jump Location
TABLE 238-1Characteristics of Blood Products
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TABLE 238-1 Characteristics of Blood Products
Component Shelf Life Volume/Unit (mL) Approximate Content/Unit* Initial Dose Dosage Effect
Packed red blood cells (PRBCs) 21–42 d 250–350

Red cells 65%–80%

Plasma 10–20 mL

Adult: 2 units

Pediatrics: 10–15 mL/kg

 Raises hemoglobin concentration approximately 2 grams/dL (20 grams/L) or hematocrit by 6% in adults (2–3 grams/dL [20–30 grams/L] or 7%–9% in children)
Platelets (apheresis-collected single-donor platelet concentrate) 5 d 250–300 Platelets 3–6 × 1011 1 unit or 5 mL/kg Raises platelet count by up to 50,000/mm3 (50 × 109/L), but less in many cases
Platelets (pooled donor platelet concentrate, rarely used in the United States) 5 d 50–60 Platelets 8–9 × 1010 6 units or 5 mL/kg Raises platelet count by up to 50,000/mm3 (50 × 109/L), but less in many cases
Fresh frozen plasma (FFP) 1 y frozen and up to 5 d after thawing 200–250

Each coagulation factor about 200–250 units

Fibrinogen 400–500 milligrams

 Four units or 15 mL/kg Raises most coagulation factors levels approximately 20%; volume issues may make factor correction difficult; benefits are transient
Cryoprecipitate 1 y frozen and 4 h thawed 20–50

Factor VIII 80–140 units

Fibrinogen 225–420 milligrams

von Willebrand factor in variable amounts

Factor XIII and fibronectin in some amounts

 0.2 units/kg or 10–15 units in an adult Increases fibrinogen 50–100 milligrams/dL (0.5– 1.0 grams/L)

*Unless specifically prepared, most blood-derived products contain some small amount of WBCs, red blood cells, platelets, and plasma in addition to the specific component.

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Table Graphic Jump Location
TABLE 238-2Coagulation Factor Products
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TABLE 238-2 Coagulation Factor Products
Type of Product* Initial Dose Comments and Approved Indications

Fibrinogen concentrate (human)

RiaSTAP® (CSL Behring)

Dosed to increase fibrinogen level from baseline to over 150 milligrams/dL (1.5 grams/L)

If baseline fibrinogen level unknown, administer 70 milligrams/kg

Each vial contains 900–1300 milligrams of fibrinogen

Acute bleeding episodes in patients with congenital fibrinogen deficiency

Three-factor prothrombin complex concentrate (human)

Profilnine SD® (Grifols Biologicals)

Bebulin VH® (Baxter Healthcare Corporation)

 Dosed according to desired factor IX increase

Contains factors II, IX, and X

Treat hemophilia B (factor IX deficiency)

Four-factor prothrombin complex concentrate (human)

Kcentra® or Beriplex® P/N (CSL Behring)

Octaplex® (Octapharma)

Dosed in factor IX units according to ...

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