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Transfusion

  • Criteria for transfusion

    • Acute hemorrhage > 25-30% of blood volume (~1500mL)
    • Surgical blood loss > 2 L
    • Symptomatic chronic anemia with underlying cardiopulm disease, or Hb < 7 (Hct < 30)
  • Admission orders

    • Admit: Observation Unit
    • Diagnosis: Transfusion
    • Condition: Stable
    • Vital Signs: Routine, q 15 min during transfusion
    • Allergies:
    • Nursing: Transfuse 2 units of typed and crossed packed RBCs
    • Diet: Regular
    • Activity: as tolerated
    • Labs:
    • Type and cross 2 units of packed RBCs, and transfuse each over 2 hours
    • Post-transfusion hematocrit (Hct rise 3-4/unit transfused)
    • Anemia workup if unknown
    • FOBT, endoscopy if suspect GI bleed
    • IV: None
    • Special: Moniter transfusion reaction
    • Medications:
      • Diphenhydramine 25-50 mg IV or PO prn itching or urticaria
      • Acetaminophen 650 mg PO q 6 hours prn fever or pain
      • EPO or darbopoietin for kidney disease, HIV or chemo-related anemia
      • Iron if iron deficiency (administer with Vit C or orange juice)
      • Vitamin B12 if deficient (daily PO or monthly IM)
      • Folate if deficient
      • immunosuppression if autoimmune hemolytic anemia
    • Call HO: if fever, tachycardia or hypotension (suspect transfusion reaction), stop transfusion.
  • Blood bank

    • CMV negative blood: CMV-negative pts who are immunocompromised (HIV, transplant)
    • Leukocyte-reduced blood: Pts with a hx of febrile transfusion reactions, marrow transplant
    • Gamma-irradiated blood: Pts with marrow transplant, aggressive chemo or lymphoproliferative malignancies.
  • Transfusion reaction management

    • Stop transfusion
    • ABCs
    • NS 250 mL/h
    • Check blood bag
    • Labs:
      • free serum hemoglobin
      • direct Coomb's test
      • urine hemoglobin
      • repeat crossmatch
    • Blood bank consult
  • Discharge

    • education: diet, nutrition
    • f/u CBC

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.