Blood Transfusion

The full clinical picture should be realised as over transfusion can be as harmful as under transfusion.

Consider targeting haemoglobin 7g/dL (and 9g/dL in those with unstable ischaemic heart disease).

Consider Platelet transfusion in those patients actively bleeding with a platelet count below 50 X 10 9/Litre. Do not offer platelets to those actively bleeding but haemodynamically stable.

Offer Fresh Frozen Plasma (FFP) to patients actively bleeding with a PT (prothrombin time) or APTT (activated partial thromboplastin time) greater than 1.5 times normal.

Offer cryoprecipitate if a patient’s fibrinogen level remains less than 1.5g/litre despite FFP use.

Offer Prothrombin Complex Concentrate to patients taking warfarin and actively bleeding (concomitant vitamin K should also be given).[20]

Thromboelastography can also be used if readily available to guide transfusion of clotting products.