• Cryoprecipitate (Fibrinogen)

    • Fibrinogen <100 mg/dL or <150 mg/dL if actively bleeding/massive hemorrhage

    • <100 1 Pools = 10 units

    • <50 2 pools = 20 units

    • fibronogen min after completion

  • Platelet Pheresis

    • transfuse if Platelets <10k, <20k if Fever/sepsis, <50 if Active bleeding/procedure, <100 if Neurosurgery/head bleed

    • 1 unit → ↑ platelets ~30–60k

    • CBC 60 min after transfusion

  • RBC

    • transfuse if < Hgb 7 g/dL for stable patients or < Hgb 8 g/dL for stable patients with cardiovascular disease or symptomatic anemia. transfuse if Active massive bleeding

    • CBC 1 hr after transfusion

  • FFP (Fresh Frozen Plasma) (ALL Factors)

    • transfuse if INR >1.5–2 + active bleeding/procedure, DIC, Massive transfusion, Urgent warfarin reversal (if PCC unavailable)

    • 2–4 units initially

    • INR/PT/PTT 60 mins after completion

FFP = replaces all clotting factors

FFP contains:

  • All clotting factors (II, VII, IX, X, etc.)
    -also Fibrinogen but that is mainly through Cryo

  • Plasma proteins

  • Albumin

  • Antithrombin and other coagulation regulators

Main indications (↑ INR / ↑ PT / ↑ PTT)

  • Active bleeding + elevated INR/coagulopathy

  • Warfarin reversal with bleeding

  • Liver failure with bleeding

  • DIC with bleeding

  • Plasma exchange (TTP)

  • Massive transfusion with coagulopathy

RBC transfusion

  • Hgb 7 g/dL hemoglobin threshold for stable patients

  • Hgb 8 g/dL hemoglobin threshold for stable patients with cardiovascular disease

  • Irradiated blood (exposed to radiation to inactivate donor lymphocytes (T cells)
    → Immunocompromised patients
    (hematologic malignancy, stem cell transplant, Hodgkin lymphoma, chemo, congenital immunodeficiency, family-directed donation)
    → Prevents donor lymphocytes from attacking the patient (transfusion-associated GVHD) in immunocompromised patients.

  • Washed blood
    → Prior severe allergic transfusion reaction or IgA deficiency
    → Removes donor plasma proteins that can trigger severe allergic/anaphylactic transfusion reactions (especially in IgA deficiency).

Platelet Pheresis

Main indications:

  • Thrombocytopenia

  • Platelet dysfunction

  • Active bleeding

  • Before procedures

  • <10k → prophylactic

  • <20k + fever/sepsis

  • <50k before procedures or Active bleed

  • <100k neurosurgery

1 unit → ↑ platelets ~30–60k

Cryoprecipitate (mainly fibrinogen)

  • Fibrinogen

  • Factor VIII

  • vWF

  • Factor XIII

Main indications:

  • Low fibrinogen (<100–150)

  • DIC with bleeding

  • Massive hemorrhage

  • Liver failure bleeding

FFP + Cryoprecipitate

Especially in:

  • Massive hemorrhage

  • DIC

  • Trauma

  • OB hemorrhage

  • Severe liver disease bleeding

Because patients can have:

  • ↑ INR/PTT → needs FFP
    AND

  • ↓ fibrinogen → needs Cryo