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Red Cell Transfusion Guidelines:

Posted by sammy on February 5, 2013 at 4:30 PM

Major Products Available: Red Blood Cells (pediatric pack/red cell concentrate)




Red Blood Cells (RBCs) are prepared from Whole Blood

(WB) by the removal of most of the plasma. RBCs are

stored in one of several saline-based anticoagulant/

preservative solutions, yielding a haematocrit (Hct)

between 55-80%.




The major indication for RBC product transfusions is

prevention or treatment of symptoms of tissue hypoxia

by increasing the oxygen-carrying capacity of blood.

The transfusion requirements of each patient should be

based on clinical status rather than on predetermined

Hct or hemoglobin (Hgb) values.



haemorrhagic shock due to:



Invasive procedure

Medical conditions (e.g. Gastro-intestinal



Active bleeding with:

Blood loss in excess of 20% of the patients

calculated blood volume or

Blood loss with 20% decrease in blood

pressure and or 20% increase in heart rate


Symptomatic anemia with

Heamoglobin less than 8 g/dl

Angina pectoris or Central Nervous System

(CNS) symptoms with heamoglobin less

than 10 g/dl

UCG 2010





7. Guidelines for appropriate use of blood


Asymptomatic aneamia

Preoperative heamoglobin less than 8 g/dl


Anticipated surgical blood loss greater than

500 ml


Sickle cell disease:

When general anesthesia is anticipated, when

signs and symptoms of anemia are present, or

for exchange transfusion when indicated (e.g.

pregnancy, stroke, seizures, priapism, or acute

chest syndrome).

Anemia due to renal failure/hemodialysis

refractory to erythropoietin therapy.

Red blood cells products should not be

transfused for volume expansion only or to

enhance wound healing.




Red Cells require compatibility testing and should

be ABO and Rh compatible. One unit of RBCs should

increase the hemoglobin of a 70 kg adult by

approximately 1 gm/dL in the absence of volume

overload or continuing blood loss. Clinical signs and

symptoms should be assessed after every unit of

red blood cell transfusion so that the need for

additional transfusion and the patient’s blood

volume status can be assessed. Patients with

chronic anemia, who are volume expanded, and

other patients susceptible to fluid overload should

be transfused slowly. The initial transfusion period

should be carefully monitored with a slow

transfusion rate to allow the early detection of a

transfusion reaction. Transfusion should be

completed within 4 hours per unit. Alternatively the

unit may be divided by the Blood Bank in advance

and administered in two or more aliquots.


UCG 2010





7. Guidelines for appropriate use of blood

Alternative Therapy:


Diagnosis and treatment of nutritional anemias

(iron, B12, and folate deficiencies) will usually avoid

the need for transfusion. Erythropoeitin has been

shown to reduce transfusion needs in patients with

chronic renal failure and other patients with chronic

anemia. Autologous transfusion (pre-operative

donation, isovolemic hemodilution, perioperative

blood recovery, and post-operative blood salvage)

has been shown to reduce red cell requirements in

carefully selected patients. DDAVP, aprotinin, and

other pharmacologic agents have been shown to

reduce blood loss during some surgical procedures.

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