Transfusion Targets

Transfusion strategies aim to balance the harm of anaemia or coagulopathy versus that of transfusion, therefore all targets vary depending on the clinical situation.

Ideally, a patient should be prevented from becoming anaemic or coagulopathic in the first place.

Haemoglobin

Although anaemia is detrimental, it is apparent that correction to a normal haemoglobin is also not helpful.

  • >70g/L: Essentially always appropriate
  • >80g/L: Coronary artery disease, active ACS, or ECMO
  • 80-90g/L: Active haemorrhage
    Less restrictive strategy appropriate to keep a margin of safety.
  • >90g/L: Essentially never appropriate

Platelets

  • >20×109/L: Essentially always appropriate
  • >50×109/L: Most surgery or invasive procedures
  • >100×109/L: Select surgery or procedures
    Neurosurgery, intraocular surgery, neuraxial anaesthesia.
  • Generally not appropriate for:
    • ITP or other immune-related destruction
    • TTP
    • HUS

Coagulation Factors

Coagulation factor replacement:

  • Can be performed with:
    • FFP
    • Freeze-dried plasma
    • Factor concentrates (PCC)
    • Cryoprecipitate
  • Appropriate for:
    • Coagulopathy
      • DIC
      • Massive transfusion
      • Liver disease
    • Single-factor deficiency when single-factor replacement is not available
    • Reversal of warfarin when PCC unavailable
    • Plasma exchange
      Though albumin is generally preferred.

Targets:

  • INR <1.5-2.0
    Invasive procedures are generally safe below 2, though lower thresholds may be requested for high risk procedures.
  • Fibrinogen >1-2.0

Antifibrinolytics

  • Benign and so recommended in almost all cases
  • Tranexamic acid
    • 1g bolus
    • 1g infusion over 8h ours

References

  1. Yazer MH, Waters JH, Spinella PC, et al. Use of Uncrossmatched Erythrocytes in Emergency Bleeding Situations. Anesthesiology. 2018;128(3):650-656.
  2. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.