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Versiti Adult Blood Utilization Guidelines – Summary of Thresholds for Blood Component Transfusion
Overview:
Tables below summarize conditions and recommended triggers for blood component transfusions based on laboratory values established as safe in clinical trials or from expert opinion (see respective section in Guidelines). Patient assessment and clinical judgement in conjunction with these triggers result in best transfusion practice. Clinical assessment may not support the need for transfusion in all patients.
RED BLOOD CELLS
| Condition | Trigger for Transfusion: Hemoglobin |
|---|---|
| Active bleeding (acute blood loss ≥30%) | Maintain Hgb above 7-8 g/dL |
| Hospitalized Patient | |
| Critically ill (ICT, sepsis, major burns) | ≤7 g/dL |
| Upper gastrointestinal bleeding (no shock) | ≤7 g/dL |
| Post-op surgery (including cardiac and non-cardiac) | ≤7-8 g/dL |
| Hemodynamically stable with pre-existing cardiac disease | ≤7-8 g/dL |
| Acute MI, unstable, on-going angina (unstable patient) | ≤8 g/dL |
| Undergoing hematopoietic stem cell transplant (HSCT) | ≤7 g/dL |
| Outpatient hematology/oncology patient | ≤8 g/dL |
PLATELETS
| Condition | Trigger for Transfusion: Platelet Count |
|---|---|
| Therapeutic: Active bleeding | <50,000/µL |
| Prophylaxis: | |
| Hematology/oncology patients | <10,000/µL (stable); <20,000/µL (w/ risk factor) |
| Surgery/invasive procedure | <50,000/µL |
| CNS, eye, or airway surgical procedure | <100,000/µL |
| IR procedures – low risk of bleeding1 | <20,000/µL |
| IR procedures – high risk of bleeding1 | <50,000/µL |
| Platelet function defect with bleeding or prior to procedure | Any platelet count |
1 Refer to Apheresis Platelet section
PLASMA
| Condition | Trigger for Transfusion: INR or PTT |
|---|---|
| Active bleeding | INR ≥1.8 or aPTT >1.5x upper limit of normal |
| Prophylaxis prior to surgery/invasive procedure2 | INR ≥1.8 or aPTT >1.5x upper limit of normal |
| Urgent reversal of warfarin (bleeding or prior to procedure)2 | INR ≥1.8 |
| IR procedures – low risk of bleeding2,3 | INR ≥3.0 |
| IR procedures – high risk of bleeding2,3 | INR ≥1.8 |
| Treatment of TTP | N/A |
| Replacement fluid for TPE when bleeding risks | N/A |
2 Correction of INR is typically 6 hrs if Vitamin K given IV or 24 hrs if given PO. If life-threatening bleeding, consider PCC instead of plasma.
3 Refer to Plasma section
CRYOPRECIPITATE
| Condition | Trigger for Transfusion: Fibrinogen |
|---|---|
| Hypofibrinogenemia with bleeding or undergoing invasive procedure | Fibrinogen <150 mg/dL |
| Post-partum massive bleeding | Fibrinogen <200 mg/dL |
| Dysfibrinogenemia with bleeding4 | Any fibrinogen level |
4 Consider fibrinogen concentrates for dysfibrinogenemia. See Factor Concentrates section.
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