View source for Blood product order with questionable indication

{{Top
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author2=
}}
If the blood bank wants you to help accepting or rejecting a blood product order with questionable indication:
#Preferably, check the patient's blood type, and check the supply of that particular blood type at the blood bank, including anticipated deliveries and potential blood-consuming surgeries in the near future.
#Look up the patient's '''history''', especially the lab values most related to the indication.<br>- If the indication is not clear from the records, you may first contact the patient's nurse or equivalent to ask for indications.<br>- If still not clearly indicated, you may ask the ordering clinician or the patient's doctor if the transfusion can wait or be canceled (but inform that the final decision will be your attending, if applicable).
#If you are dealt multiple such patient cases at the same time, look up the histories of each before forming an opinion on whether to release the blood product or not.
#Form your own opinion, and bring the case(s) to your attending (if applicable), along with your recommendation.

==Example thresholds==
;Red blood cells<ref name=danbury>{{Danbury}}</ref>
{|class=wikitable
! Hb !! Indications !! Dose
|-
| Less than or equal to 7 g/dL || Hospitalized hemodynamically stable patients ||rowspan=4| 1 unit at a time.
|-
| Less than or equal to 8 g/dL ||
* Preexisting cardiac disease
*Immediately postoperative
|-
| Less than or equal to 10 g/dL || Hemoglobinopathy
|-
| Less than or equal to 12 g/dL|| ECMO
|}
However, the following conditions generally do not have any specified threshold, and a clinician's judgement generally takes precedence:
*Acute coronary syndrome
*Bone marrow suppression (diagnosed or after chemotherapy)
*Surgical procedures with high anticipated blood loss
*Active Bleeding (includes massive bleeding)
*Symptomatic anemia (angina, dyspnea, syncope, TIA)

;Platelets<ref name=danbury/>
{|class=wikitable
! Platelet count !! Indications !! Dose (each dose having a minimum of 5.5×10<sup>10</sup> platelets<ref name="pmid25369586">{{cite journal| author=Squires JE| title=Indications for platelet transfusion in patients with thrombocytopenia. | journal=Blood Transfus | year= 2015 | volume= 13 | issue= 2 | pages= 221-6 | pmid=25369586 | doi=10.2450/2014.0105-14 | pmc=4385069 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25369586  }} </ref>
|-
| Less than or equal to 10,000/uL || Platelet count alone indicates ||rowspan=5| 1 dose at a time
|-
| Less than or equal to 20,000/uL || 
*Minor surgical procedure 
*Patients receiving heparin; all outpatients or those to be discharged
|-
| Less than or equal to 50,000/uL ||
*Bleeding
*Hemorrhagic diathesis
*Major elective / invasive procedure
*Lumbar Puncture
|-
| Less than or equal to 75,000/uL || ECMO 
|-
| Less than or equal to 100,000/uL ||
*Life threatening bleed
*Closed space bleed
*Neurosurgery
|}
No specified threshold:
*Platelet dysfunction (i.e. Medication, disease related or after bypass) with bleed and/ or need for an invasive procedure

;Fresh frozen plasma<ref name=danbury/>
{|class=wikitable
! INR level !! Indications !! Dose Recommended
|-
| Greater than 1.5 || Neurosurgical patients, neuraxial anesthesia and lumbar puncture ||rowspan=2| Generally 10-15 ml/kg, and may be capped at a maximum of 5 doses.<ref name="pmid34058023">{{cite journal| author=Carson JL, Ness PM, Pagano MB, Philipp CS, Bracey AW, Brooks MM | display-authors=etal| title=Plasma trial: Pilot randomized clinical trial to determine safety and efficacy of plasma transfusions. | journal=Transfusion | year= 2021 | volume= 61 | issue= 7 | pages= 2025-2034 | pmid=34058023 | doi=10.1111/trf.16508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34058023  }}</ref> [https://www.mdcalc.com/plasma-dosage An online calculator is available]
|-
| Greater than or equal to 1.8 || 
*With bleeding 
*Urgent reversal of warfarin with bleeding or risk of bleeding or not responsive to vitamin K
*Need for an invasive procedure 
|}
No specified threshold:
*Plasma exchange: Therapy of TTP and HUS
*Selected factor deficiencies, congenital or acquired, for which no specific factors are available
*Massive transfusion protocol
*Acute angioedema or hereditary C1 esterase deficiency
Serial INR measurements assessed after each 2-3 units of FFP will assist in guiding subsequent FFP transfusions. 

;Cryoprecipitate<ref name=danbury/>
{|class=wikitable
! Fibrinogen level !! Indications !! Dose recommended
|-
| Less than or equal to 100 mg/dL || 
*Hypofibrinogenemia with bleeding 
*Hypofibrinogenemia with invasive procedure
|| 1 dose (minimum 150 mg fibrinogen per dose<ref name="pmid24972790">{{cite journal| author=Nascimento B, Goodnough LT, Levy JH| title=Cryoprecipitate therapy. | journal=Br J Anaesth | year= 2014 | volume= 113 | issue= 6 | pages= 922-34 | pmid=24972790 | doi=10.1093/bja/aeu158 | pmc=4627369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24972790  }} </ref>)
|}
No specified threshold:
*Deficiency of Factor XIII (1-2 doses)
*Dysfibrinogenemia with bleeding or invasive procedure (1 dose)
*Uremia with bleeding or invasive procedure when other modalities are unsuccessful (1 dose)
*Massive bleeding (1-2 doses)
*Bleeding or high risk of bleeding in patients with von Willebrand’s Disease (vWD) unresponsive to DDAVP, or when factor concentrates are not readily available.
*Deficiency of factor VIII – only if factor VIII concentrates are not available 
{{Bottom}}