Transfusion Cheatsheet
Transfusion products, factors, and immune globulins.
Transfusion cheatsheet
3 sections
Blood component dosing, handling, preparation time, and special precautions.
Blood Components Available from the Blood Transfusion Laboratory
| Component | Indications | Dose | Handling | Key notes |
|---|---|---|---|---|
Red cell concentrate (in SAGM) | To correct inadequate tissue oxygen delivery. | 15 mL/kg, expected hemoglobin increase about 20 to 30 g/L. | Volume approximately 250 mL per unit, hematocrit about 0.6 Uncrossmatched: 5 minutes by physician request only Urgent: 30 minutes Routine: average 2 hours, can take 4 hours Use blood filter and transfuse within 4 hours after issue | Crossmatch required Must be ABO compatible Dedicated unit noted for neonates with birth weight under 1000 g Call Blood Transfusion Laboratory when urgent or uncrossmatched blood is needed |
Frozen plasma (FP) | Vitamin K deficiency Severe liver disease with coagulopathy Treatment of DIC Massive and exchange transfusions | 10 to 15 mL/kg | Contains all coagulation factors and complement Approximate volume 270 mL Urgent: 30 minutes Routine: 1 to 2 hours Use blood filter and transfuse within 4 hours | Should be ABO compatible. |
Octaplasma SD human plasma | TTP/HUS Allergic reactions to plasma | 10 to 15 mL/kg | Approximate volume 200 mL. | Presented on the sheet as a plasma product alongside FP. |
Cryoprecipitate | Hypofibrinogenemia with fibrinogen <1 g/L Dysfibrinogenemia | 1 unit per 10 kg raises fibrinogen by about 0.5 g. | Volume 6 to 10 mL Contains fibrinogen (average 200 mg per unit), factor VIII, vWF, and factor XIII Urgent: 30 minutes Routine: 1 to 2 hours Use blood filter or IV push filter and transfuse within 4 hours | Monitor recipient response. |
Cryo free FP (cryosupernatant) | Plasma infusion or plasma exchange for thrombotic thrombocytopenic purpura. | 10 to 50 mL/kg | Plasma deficient in high molecular weight multimers of vWF Approximate volume 250 mL Urgent: 30 minutes Routine: 1 to 2 hours Use blood filter and transfuse within 4 hours | Should be ABO compatible. |
Platelet concentrates | Bleeding from thrombocytopenia or platelet function abnormality Prophylaxis for platelet count <10 x 10^9/L Prophylaxis for invasive procedures when platelet count <50 x 10^9/L | Neonates: 15 mL/kg Others: 5 to 10 mL/kg, up to 300 mL adult dose | Available as Buffy coat pool (300 mL) or single donor platelets, SDP (250 mL) One SDP product equals a Buffy coat pool of 4 Urgent: 30 minutes Routine: 1 to 2 hours Use blood filter or IV push filter Transfuse within 4 hours of issue | Should be ABO compatible Monitor recipient response 5 to 10 mL/kg raises platelet count by about 30 to 60 x 10^9/L Check post-transfusion count 10 minutes to 1 hour later, less in chemotherapy patients |
HLA-matched single donor platelets (SDP) | Refractory to Buffy coat pool or SDP due to HLA antibodies. | Contact Blood Transfusion Laboratory. | 48 hours notice usually required Use blood filter Transfuse within 4 hours of issue | Coordinate availability and ordering with the Blood Transfusion Laboratory. |
Albumin 5% and 25% | Volume expansion. | 0.5 to 1 g/kg, maximum 6 g/kg/day. | Available sizes listed as 2.5 g, 12.5 g, and 25 g Issued on demand No filter required | Order in grams and mL. |
Use the 170 to 260 micron blood filter. The 40, 80, or 150 micron blood filters are appropriate alternatives.
Factor products, indications, source details, and dosing notes.
Factor Concentrates Available from the Blood Transfusion Laboratory
| Factor / product | Indications | Source and viral inactivation | Dosing and ordering notes |
|---|---|---|---|
Fibrinogen Haemocomplettan-P (CSL Behring) RiaSTAP (CSL Behring) | Congenital or acquired fibrinogen deficiency. | Human plasma, pasteurized. | 1 g (50 mL) is listed as equivalent to 5 units of cryoprecipitate SAP Order listed as 1 g (50 mL) |
Factor VII F VII concentrate (Baxter) | Factor VII deficiency requiring replacement therapy. | Human plasma, steam treated. | Dose (IU) = desired % increase x body weight (kg) / 2 12 hour intervals SAP |
Factor VIIa (room temperature product) Recombinant F VIIa / NiaStase RT | Factor VIII deficiency with high titre inhibitors Hereditary factor VII deficiency | Recombinant, DNA technology. | Vial sizes: 1000 mcg, 2000 mcg, 5000 mcg Reconstituted with diluent (water): 1 mL = 1000 mcg 35 to 90 mcg/kg at 2 to 6 hour intervals 15 to 30 mcg/kg at 4 to 6 hour intervals |
Factor VIII Kogenate FS (Bayer) Helixate (CSL Behring) Advate (Baxter) Xyntha (Pfizer) | Factor VIII deficiency requiring replacement therapy. | Recombinant, DNA technology. | Dose (IU) = desired % increase x body weight (kg) / 2 8 to 24 hour intervals Usual dose: 25 to 40 units/kg |
Anti-inhibitor coagulant complex (FII, VII, IX, X) FEIBA NF (Baxter) | Factor VIII deficiency with inhibitors. | Human plasma, vapour heated and nanofiltered. | Dose range: 50 to 100 units/kg 6 to 12 hour intervals Daily maximum: 200 units/kg |
vWF Humate-P (CSL Behring) Wilate (Octapharma) | Von Willebrand disease not responsive to DDAVP. | Human plasma, pasteurized Human plasma, solvent/detergent | Dose (IU vWF:RCoF) = desired % increase of vWF:RCoF (IU/dL) x body weight (kg) / 1.5 8 to 12 hour intervals |
Factor IX BeneFIX (Pfizer) Immunine VH (Baxter) | Factor IX deficiency requiring replacement therapy. | BeneFIX: recombinant, DNA technology Immunine VH: human plasma, vapour heated | Dose (IU) = desired % increase x body weight (kg) x 1.2 Usual dose: 50 units/kg |
Factor XI Factor XI (BPL) | Factor XI deficiency requiring replacement therapy. | Human plasma, heat treated. | Dose (IU) = desired % increase x body weight (kg) / 2 SAP |
Factor XIII Fibrogammin P (CSL Behring) Tretten (Novo Nordisk) | Congenital factor XIII deficiency requiring replacement therapy. | Fibrogammin P: human plasma, pasteurized Tretten: recombinant, DNA technology | Fibrogammin P: 10 U/kg every 4 weeks, SAP Tretten: 35 IU/kg monthly |
Prothrombin complex (FII, VII, IX, X) Octaplex (Octapharma) Beriplex (CSL Behring) | Acquired or hereditary deficiency of factors II, VII, IX, and X. | Human plasma, solvent/detergent Human plasma, pasteurized | Vial size listed as 500 IU. |
AT III Antithrombin III (Baxter) | Congenital or acquired AT III deficiency. | Human plasma, heat treated. | Dose (IU) = desired % increase x body weight (kg) Usual dose: about 100 IU/kg |
Protein C Ceprotin (Baxter) | Congenital and acquired protein C deficiency. | Human plasma, vapour heated. | Vial size: 500 IU SAP |
C1 inhibitor Berinert P (CSL Behring) | Hereditary angioneurotic oedema. | Human plasma, vapour heated. | Dose (IU) = desired % increase x body weight (kg) / 2 |
Fibrin sealant Tisseel (Baxter) Floseal (Baxter) | Achieve hemostasis, seal or glue tissue, and support wound healing. | Tisseel listed as human plasma, vapour heated. | Tisseel kit sizes: 2.0 mL, 4.0 mL, 10.0 mL Floseal kit size: 5 mL |
Order dose to the nearest vial.
SAP = Special Access Program.
Call the Blood Transfusion Laboratory for availability and ordering procedure.
Immune globulin dosing and administration details.
Immune Globulins Available from the Blood Transfusion Laboratory
| Product | Indications | Dose | Administration | Key notes |
|---|---|---|---|---|
Immune globulin (human) Example: GamaSTAN | Prophylaxis for hepatitis A contact Travel less than 3 months Travel more than 3 months Prophylaxis for measles | 0.02 mL/kg 0.02 mL/kg 0.06 mL/kg 0.25 to 0.5 mL/kg | Intramuscular injection. | 2 mL vial. |
Varicella zoster immune globulin VariZIG | Prophylaxis for chicken pox. | 125 units per 10 kg Maximum 625 units | Intramuscular injection. | 125 units per vial. |
Hepatitis B immune globulin Examples: HyperHEP B, HepaGam | Infants of HBsAg-positive mothers Hepatitis B post exposure | 0.5 mL 0.06 mL/kg | Intramuscular injection. | 0.5 mL, 1 mL, and 5 mL vials. |
Tetanus immune globulin HyperTET | Prophylaxis for tetanus. | >7 years: 250 units <7 years: 4 units/kg | Intramuscular injection. | 250 units per vial. |
Rho(D) immune globulin WinRho SDF | Treatment of ITP Transfusion of Rh-positive blood | 40 to 75 mcg/kg IV 120 mcg IV once | Intravenous infusion No filter needed | Available sizes: 120 mcg (600 IU), 300 mcg (1500 IU), 1000 mcg (5000 IU) For IM dose, consult product insert |
Immune globulin IV (IVIG), mainly 10% solutions Gamunex / IGIVnex 10% Gammagard Liquid 10% Privigen 10% Octagam 10% | NAIT/HDFN Hypo/agammaglobulinemia Guillain-Barre syndrome Vasculitis/MAS Immune thrombocytopenia Bone marrow transplant Dermatomyositis / polymyositis Kawasaki disease Retreatment note: use Gammagard SD 5% | NAIT/HDFN: 2.5 g per dose or 0.5 to 1 g/kg IV once, repeat in 12 hours Hypo/agammaglobulinemia: 600 mg/kg/month Guillain-Barre syndrome: 1 g/kg for 2 days Vasculitis/MAS: 2 g/kg, max 70 g Immune thrombocytopenia: 0.8 to 1 g/kg and reassess in 24 to 48 hours Bone marrow transplant: 400 mg/kg/dose IV when IgG <4 g/L Dermatomyositis / polymyositis: 2 g/kg in 1 day twice weekly for 5 weeks, then monthly Kawasaki disease: 2 g/kg once, max 70 g | IV infusion, no filter needed Privigen and Kawasaki patients: 0.3, 0.6, 1.2, then 2.4 mL/kg/hr in 15 minute steps; then 3.6 mL/kg/hr for 30 minutes and increase slowly if tolerated Compatible with D5W, not 0.9% NaCl Octagam 10% is compatible with D5W and 0.9% NaCl | Vial sizes: 2.5 g (25 mL), 5 g (50 mL), 10 g (100 mL), 20 g (200 mL) Maximum rate for Kawasaki disease patients: 3.6 mL/kg/hr Maximum rate for Privigen 10% and Octagam 10%: 7.2 mL/kg/hr Maximum rate for Gammagard Liquid 10%: 8 mL/kg/hr Maximum rate for Gamunex / IGIVnex 10%: 8.4 mL/kg/hr |
Vivaglobin 16% Hizentra 20% | Severe reaction to IVIG. | 100 to 200 mg/kg/week. | SubQ injection Maximum 15 mL per injection site | Vivaglobin 16%: 10 mL (160 mg/mL), maximum rate 20 mL/hr Hizentra 20%: 5, 10, 20 mL (200 mg/mL), maximum rate 25 mL/hr |
CMV immune globulin Cytogam | CMV prophylaxis CMV disease Epstein-Barr virus disease | CMV prophylaxis: 150 mg/kg per dose EBV disease: 100 to 200 mg/kg every 2 days for 3 weeks, then weekly for 3 weeks | Intravenous infusion Use 15 micron filter Rate: 0.3 mL/kg/hr for 30 minutes, then 0.6 mL/kg/hr for 30 minutes Maximum rate 1.2 mL/kg/hr | 2.5 g in 50 mL Consult Infectious Disease Maximum volume 75 mL/hr |
Order dose to the nearest vial.