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Chapter 238: Transfusion Therapy

Clinton J. Coil; Sally A. Santen

INTRODUCTION

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

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.

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 pretreatment INR

Contains ...

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