Info

Management

Haematocrit

<0.30

Transfuse red cells

Platelet count

<75 x 109/L

Transfuse platelets

Fibrinogen

<1.0g/L

Transfuse cryoprecipitate

PT ± APTT ratio

>1.5 x control

Transfuse FFP

Red cell transfusion

• Full crossmatch takes 30-40 minutes.

• Uncrossmatched group-specific blood can be available in 10 minutes.

• Uncrossmatched group O Rh (D) -ve blood may be transfused in the emergency situation until group-specific blood can be made available; group O Rh (D) +ve red cells may be given to males and older women if necessary.

Platelet transfusion

• Usually available within 10-15 minutes.

• Standard adult dose (6 units equivalent) will raise platelet count by ~60 x 109/L in absence of dilution or consumption.

• As platelets do not carry Rh antigens, type incompatible platelets may be administered when necessary; Rh immune globulin should be administered when a Rh -ve patient has received Rh +ve platelets.

• 6 units of platelets contain ~300mL plasma.

Fresh frozen plasma

• Takes up to 30 minutes to thaw; dose required ~10mL/kg.

• Use immediately for optimum replacement of coagulation factors.

• Each unit contains ~200-280mL plasma and 0.7-1.0iu/mL activity of each coagulation factor

• ABO group compatible FFP should be administered—no crossmatch is required.

• If large volumes infused, serum [Ca2+] should be monitored to exclude hypocalcaemia due to citrate toxicity.

Cryoprecipitate

• Precipitate formed when FFP is thawed at 4°C; resuspended in 10-15mL plasma and refrozen at -18°C; takes up to 15 minutes to thaw and pool.

• No grouping required.

• Contains 80-100IU FVIIIC, 100-250mg fibrinogen, 50-60mg fibronectin and 40-70% of the original von Willebrand factor.

• Should be used immediately for optimum replacement of fibrinogen and factor VIIIC.

• Infusion of 8-10 bags raises fibrinogen concentration by 0.6-1.0g/L in a 70kg patient.

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