Quick Guide for patients with bleeding:
FFP
10-15 ml/kg FFP (1 u=~250 ml)
-generalized non-surgical bleeding with plt > 70,000 and PT or PTT
>1.5 times normal (or have been transfused > 1 blood volume).
-factor deficiencies (e.g., Protein C or S, Antithrombin III), if specific
factor unavailable
-urgent reversal warfarin (5-8 ml/kg)
-TTP (thrombotic thrombocytopenic purpura)
-follow PT, PTT
Platelets
1 "6-pack" should increase plt by 30-60K
(actually, UNC uses plasma apheresis - each bag is ~250cc from one
donor)
-Platelet count <10-20,000 in a non-bleeding patient with a failure
of platelet production
-Platelet count < 50,000 and impending surgery or invasive procedure
-Diffuse microvascular bleeding in a patient with documented DIC or
transfusion >= 1 blood volume and platelet count < 50,000, or lab values
not yet available.
-Diffuse microvascular bleeding following cardiopulmonary bypass or
IABP and Platelet ct. <100,000, or lab values not yet available.
-Bleeding in a patient with a qualitative platelet defect, regardless
of platelet ct.
Cryoprecipitate
0.1 u/kg cryo
-fibrinogen, Factor VIII, and Factor XIII deficiency
-von Willebrand’s disease (vWD) patients with bleeding unreponsive
to DDAVP.
-diffuse microvascular bleeding (e.g., in massively transfused patients)
with fibrinogen < 80-100 mg/dl
-check fibrinogen level before and after dose
Packed Red Blood Cells
-Symptomatic anemia in a normovolemic patient, regardless of Hgb level
-Acute blood loss of >15% of estimated blood volume, with evidence
of inadequate oxygen delivery
-Preop Hgb level <8g/dl, and operative procedure associated with
major blood loss
-Hgb < 9g/dl in a patient on a chronic transfusion regimen.