Indications for the Transfusion of Red Cells

The following indications for the transfusion of red cells were developed by Puget Sound Blood Center medical staff. They are evidence-based to the extent that evidence exists, otherwise they are felt to reflect commonly used good transfusion practice. These indications are intended only as general guidance and may not apply in all clinical situations. The final decision to transfuse or not to transfuse must be made by the patient's physician after consideration of all the clinical circumstances.

Indications for Use of Red Cells:

Red cell transfusion should be given in order to increase oxygen carrying capacity when that capacity is clinically compromised. The Hgb/Hct level alone should not be used to determine the need for transfusion; in addition one must take into consideration the patient's intravascular volume status, evidence of shock, duration and extent of anemia, and cardiopulmonary physiologic parameters.

However, some generalizations are possible.

ADULTS

Not Bleeding:

  • Reasonable in almost all patients it Hgb/Hct < 7/21
  • Almost never indicated if Hgb/Hct > 10/30
  • For Hgb between 7 and 10 (Hct between 21 and 30)—based on evidence of organ dysfunction and underlying ability to handle inadequate oxygenation.
  • Up to Hgb 10 if:
    • Mixed venous O2 sat < 70%
    • Respiratory failure, inadequate cardiac output, inadequate oxygenation
    • Oncology patients, thrombocytopenia, severe platelet dysfunction

Intra/perioperative or significant bleeding:

  • For Hgb between 6 and 10 (Hct between 18 and 30)—based on evidence of organ dysfunction, underlying ability to handle inadequate oxygenation, and potential and actual rates of bleeding.
  • Rapid blood loss exceeding 30% of blood volume.

Dose: In the absence of acute hemorrhage, transfusion should be given as single units. One unit will usually raise hematocrit by 3-4% in 70kg person.

Monitoring: Hgb/Hct and clinical situation should be evaluated after each unit transfused.

PEDIATRIC

Neonatal:

  • Severe cardiopulmonary disease--maintain hct > 35-40%
  • Moderate cardiopulmonary disease—maintain hct > 30-35%
  • Major surgery—maintain hct > 30-35%
  • Stable anemia, clinical manifestions (e.g. tachycardia, tachypnea, failure to gain weight)—maintain hct > 24%
  • Stable anemia, no clinical manifestations—maintain hct > 20

Children:

Same as adults

Dose: 10ml/kg should increase hematocrit 6-9%.

Monitoring: Hgb/Hct and clinical situation should be evaluated after each unit transfused

References

  1. Nelson AH et al. Crit Care Med 1993; 21:860-66
  2. Carson JL et al. Lancet 1996; 348:1055-60
  3. Hogue CW et al. Transfusion 1998; 38: 924-31
  4. Hebert PC et al. NEJM 1999;340:409-17
  5. Rivers E et al. NEJM 2001;345:1368-77
  6. Hebert PC et al. Crit Care Med 2001;29:227-34
  7. Wu WC et al. NEJM 2001;345:1230-36
  8. Rao SV et al. JAMA 2004;292:1555-62
  9. Lacroix J et al. NEJM 2007; 356:1609-19
  10. Ferraris VA et al. Ann Thorac Surg 2007;83:S27-86
  11. Napolitano LM et al. Crit Care Med 2009;37:3124-57

Version 12-17-10