ABC of blood Transfusion

Red cell transfusions are given to increase the hemoglobin

level in patients with anemia or to replace losses after

acute bleeding episodes.Whole blood should be considered as the choice only when treating an adult who has bled acutely and massively, where volume replacement is necessary.

Patients with chronic anemia should be transfused with

RBCs (Packed RBCS – PRBC) as volume replacement is

not required. With the current use of CPD- Adenine as

the anticoagulant preservative (AP) solution and use of

the new generation additive solutions, the red cells can be stored for 35 – 42 days.

Indications of PRBC TR?? – Since anemia is associated with adverse clinical outcomes, red cell transfusion is indicated

in conditions of anemia. The current consensus is a

restrictive policy for transfusion. Red cell transfusion is

not indicated if HB is more than 10 g/dL. PRBC transfusion  is generally indicated if the value is less than 7 g/dL. It is found that in various clinical trials, restrictive policy is safe, improves

clinical outcomes and reduces unnecessary transfusion

even in ICU setting.

The exceptions to this rule are

. Patients with symptomatic myocardial ischemia

with HB < 10g/dL should be transfused to improve

hemodynamic instability.

. In patients with acute coronary syndrome, an

individualistic approach should be followed. In

general it is desirable to have the HB equal to or

more than 10g/dL. 6.

. But, so far as index Hb is concerned some relaxation of RESTRICTIVE POLICY should be avoided,  in massive APH / perioperative blood Tr /Pl accreta-manual removal attempted or say rupture uterus:-In such  patients requiring massive transfusion (e.g.

trauma or ongoing bleeding) a strict HB threshold

may not be possible. What is  leukocyte reduction filters??  What are the rare but moderate / severe complications of RBC transfusion ?? Ans these are mostly seem to be due to contamination with leukocytes. The

complications are febrile non hemolytic transfusion

reactions, HLA alloimmunization, post-operative infection

and cardiac reperfusion injury. These complications can

be reduced by leukocyte reduction filters. Transfusion