transfusion triggers

[pbaker]

What are your transfusion triggers for packed cells, platelets and plasma?

[Malcolm Needs ☆]

Surely, it would depend on the underlying pathology (cardiac problems or no cardiac problems, as an example for red cells, is the patient to undergo surgery, as an example for platelets and plasma)?

[pbaker]

I understand that each patient may be different, but do you have general guidelines such as hgb of ???, platelet count of ???, PT INR of ???

[Bill]

Packed cells: Hgb <8 gm/dl or bleeding >15% of estimated volume

Platelet: <10,000 in non-bleeding patient; <50,000 in bleeding patient

FFP: INR >1.8 or INR >1.5 if immediate refersal is necessary for surgery or procedure.

We are 165 bed rural community hospital

[dwilmv]

We use a the following values: Hgb less than 7 as a general rule, unless patient is actively bleeding for RBCs.

Platelet count: less than 10,000 for a non-bleeding patient or 50,000 for a surgical

or bleeding patient.

We also use INR value of >1.8 for plasma

These values have been determined for use in an city hospital of about 400 beds.

[tbostock]

Hgb <7

Hgb 7-9 for patients with certain comorbidities

Plt count 10,000 non bleeding, 20,000 chemo outpatient, 50,000 bleeding or pre-op

INR 1.5

Working on getting the Hgb lower and INR higher in the future

[David Saikin]

rbc: <8 gm hgb

fp: INR > 1.6 with active bleed or going to OR now

plt: < 50000 if preop; < 10000

[fenwayman]

rbc: </=8/24

ffp: INR >1.8

platelet: <20000

rbc for Cardiac patients/Cardiac dx: target h/h: 10/30

cryo: fib <100

OR always alvailable for intraop bleed

we use a prospective blood review where we look for results prior to transfusion and hold physicians accountable for unjustified transfusions.

It was "real touchy" at first as some of the staff were reluctant to abide by the rules. Though, overtime most are now players once they realized how we, the

Transfusion Service bothe the patients and the hospital a significant savings.