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TABLE 113-4 Blood Components: Clinical Use
DONOR/RECIPIENT
COMPONENT THERAPEUTIC INDICATION GOAL COMPATIBILITY DOSAGE EFFICACY EVALUATION
Red blood cell Transfusion Anemia and/or tissue ischemia (treatment or Improve systemic and tissue oxygenation ABO compatible (cellular) and 1 unit at a time (250– Reduction of anemia-
concentrate prevention) ABO identical when achievable. 350 mL, including related symptoms, clinical
(RBCC) Hb below a given threshold (to be considered in RhD compatibility is required in additive solution), improvement
relation with clinical symptoms): <7 g/dL for patients young and childbearing females, repeated per clinical Increased Hb (+1 g/dL) and
hemodynamically stable, except for patients and whenever possible if status and Hb level hematocrit (+3%)
undergoing orthopedic surgery, cardiac surgery, or multitransfused
with preexisting cardiovascular disease (<8 g/dL) as RhC/c/E/e; Kell-compatible
well as for patients with acute coronary disease (<9–10 RBCCs are required in frequently
g/dL). Such thresholds do not apply to neonates and transfused patients. Additional
patients with severe thrombocytopenia and chronic compatibility may be required
transfusion-dependent anemia. depending on the clinical setting
Not recommended: nutritional anemia (iron, vitamin B12, and screening results.
or folate deficiency)
RBC exchange Anemia/sickle cell crisis in hemoglobinopathies (sickleReplace altered RBCs with donor 25–30 mL/kg Sickle cell disease: reduced
cell disease, thalassemia) RBCs and compensate for hemolysis, percentage of HbS
prevention of sickle cell occlusive crisis
Platelet concentrates (PCs) (from Thrombocytopenia-related bleeding disorders: Correct impaired primary hemostasis, ABO identical preferable; if 0.5–0.7 × 1010 Prevention and/or resolution of
pooled whole blood–derived platelets treatment (cold or room temperature PC) or prevention including vessel healing not, ABO compatible (cellular) platelets/kg bleeding
or single donor apheresis), maintained (room temperature PC) Cold stored platelets, despite lower with low-titer anti-A/B Ab; (apheresis or pooled Corrected count incrementa
at room temperature (most often) or Platelet level below a given threshold: ≤5000/µL in vivo survival, have maintained and RhD compatible preferred in whole blood–derived ≥10 × 109/L within 1 h and
at 4°C in the absence of fever or infection, ≤10,000/μL to possibly improved hemostatic capacity premenopausal women PCs) ≥7.5 × 109/L within 24 h after
20,000/μL if fever or infection; ≤50,000/μL if surgery, compared with room temperature stored HLA compatible (negative transfusion (not applicable to
DIC, endoscopy, invasive procedures; ≤80,000/μL if platelets lymphocyte crossmatch) or HLA cold/cryopreserved platelets)
neurosurgery or eye surgery identical in case of refractoriness
Acute hypovolemic coagulopathy (see below) related to the presence of anti-
HLA Ab
Not recommended: immune thrombocytopenia,
thrombotic microangiopathy, heparin-induced HPA compatible in
thrombocytopenia thrombocytopenic neonates
to HPA immunized mother
(fetal neonatal alloimmune
thrombocytopenia)
Plasma (thawed Transfusion Coagulation factor–related bleeding disorders Correct impaired hemostasis by providing ABO compatible (plasma) 10–15 mL/kg Reduced bleeding disorder
frozen, never Acute hypovolemic coagulopathy (see below) missing elements of coagulation or
frozen and fibrinolysis cascade, as well as elements
maintained at to heal injured vessel endothelium
4°C or at room Infectious disease treatment (convalescent plasma Provide Abs against relevant pathogens Not determined Infection resolution
temperature, containing pathogen-specific Abs): Argentina
freeze-dried) hemorrhagic fever, viral respiratory infections
(experimental)
Plasma exchange Pathogenic Ab removal and supplementation of Deplete pathogenic elements in ABO compatible (plasma) 45–60 mL/kg Improved disease-specific
(plasma or lacking enzyme (e.g., thrombotic thrombocytopenic the blood (auto-antibodies such as symptomatology (i.e., apyrexia
combined plasma microangiopathy or Guillain-Barre syndrome) anti-ADAMTS-13 Ab in case of TTP, and platelet recovery in case
and albumin) Pathogenic Ab removal (e.g., anti-HLA Ab prior to excess cholesterol, etc.); plasma may of TTP)
kidney transplantation) also bring anti-inflammatory and/or Reduced antibody levels (e.g.,
immunomodulatory factors such as anti-HLA antibodies prior to
immunoglobulin organ transplantation)
(Continued)

CHAPTER 113 Transfusion Therapy and Biology

889
 Oncology and Hematology PART 4

890
TABLE 113-4 Blood Components: Clinical Use (Continued)
DONOR/RECIPIENT
COMPONENT THERAPEUTIC INDICATION GOAL COMPATIBILITY DOSAGE EFFICACY EVALUATION
Whole blood Acute hypovolemic coagulopathy requiring massive Balanced provision of blood components ABO-identical or group O with Repeated per clinical Normovolemia; bleeding
transfusion maintained at 4°C and without an additive low-titer anti-A/B Ab status resolution
solution and related dilution
Multicomponent (RBCC, PC, and Acute hypovolemic coagulopathy requiring massive Appropriate ratio is under investigation; a Standard RBCC, PC, and plasma 1 RBCC/1 plasma/0.25 Normovolemia; bleeding
plasma) transfusion ratio of 1 RBCC/1 plasma/0.25 PC (platelet compatibility PC ratio, repeated per resolution
content of a whole blood) is currently clinical status
favored
Granulocyte concentrates (apheresis Severe refractory bacterial or fungal infection Correct impaired granulocyte function ABO compatible 1–2 × 1010, repeated Infection resolution (or
or a pool of whole blood–derived in patients with neutropenia (<100/μl) or with in relation to granulocytopenia or per clinical status stabilization until recovery from
granulocytes) dysfunctional granulocytes (CGD) (mainly soft granulocyte dysfunction neutropenia)
tissues and lung). Neutropenia can be acquired
(chemotherapy) or congenital. Usefulness of
granulocyte transfusions is debated. Formal proof of
efficacy is lacking.
Donor mononuclear cells Relapse of malignant hemopathy after allogeneic Graft-versus-leukemia effect (and graft N/A 105–107 T Disease specific (remission)
hematopoietic cell transplantation enhancement effect) lymphocytes/kg
Cryoprecipitate Acute bleeding coagulopathy, type II (dysfunctional Provision of fibrinogen, factor VIII, von ABO compatibility is not required 10–15 mL/unit, pool of Increased plasma fibrinogen
factor) or type III (absent factor) Von Willebrand Willebrand factor, and factor XIII 4–5 units (0.3–1 g/L)
disease, hemophilia A in the absence of factor VIII
concentrates

a
CCI calculation:
Postransfusion count (/µL) – pretransfusion count (/µL)
CCI = x Body surface area (m2 )
Number of platelets transfused x 1011

Abbreviations: Ab, antibody; CCI, corrected count increment; CGD, chronic granulomatous disease; DIC, disseminated intravascular coagulation; Hb, hemoglobin; HLA, human leukocyte antigen; N/A, not applicable; RBC, red blood cell; TTP,
thrombotic thrombocytopenic purpura.