The indication for blood transfusion depends on:
- The degree of anaemia
- The clinical conditions (high risk or presence of signs and symptoms of tissue hypoxia, cardiac decompensation, etc.)
- Presence and entity of ongoing blood loss (e.g., internal or external haemorrhage) or red cells destruction (malaria, haemolysis, sepsis, etc.)
Severe anaemia in children and infants
- Hb ≤4 g/dL (or haematocrit ≤12%), whatever the clinical condition of the patient
- Hb ≤6 g/dL (or haematocrit ≤13-18%), in case of life threatening complications, such as, clinical features
of hypoxia and cardiac decompensation, acidosis (usually causes dyspnoea), impaired consciousness,
hyperparasitaemia (>20%) or cerebral malaria, septicaemia, meningitis - Transfuse 10-15 mL/kg of packed red cells (20 mL/kg of whole blood)
Severe anaemia in adults
- Consider blood transfusion only in anaemia which is likely to cause/ has already caused clinical signs of hypoxia
- Symptomatic anaemia in adults with <8 g/dL
- Haemoglobin <10 g/dL if angina pectoris or CNS symptoms
Give the minimum number of transfusions necessary to relieve hypoxia: transfuse 1 unit in 2-4 hours (with
furosemide 40 mg IM) and re-assess. If symptoms persist give another 1-2 units
Severe anaemia in pregnancy
Pregnancy <36 weeks
- Hb ≤5 g/dL irrespective of clinical condition
- Hb 5-7 g/dL in case of established or incipient heart failure, pneumonia or other serious infection, malaria, preexisting heart disease
Pregnancy >36 weeks
- Hb ≤6 g/dL
- Hb 6-8 g/dL in case of
- Established or incipient heart failure, pneumonia or other serious infection, malaria, pre-existing heart disease
Elective caesarean section
If history of APH, PPH, previous caesarean section
- Hb is 8-10 g/dL
- Establish/confirm blood group, and save freshly taken serum for cross-matching
- Hb <8 g/dL
- Have 2 units of blood cross-matched and made available
Pre-operative anaemia
- ≤8 g/dL in case of:
- Inadequate compensation for the anaemia (symptomatic anaemia)
- Significant co-existing cardiorespiratory disease
- Major surgery or significant blood loss expected
- Pre-surgical correction has not been possible
Management of acute haemorrhage/hypovolemia
- IV fluids (crystalloids: Normal saline) is the first line in treatment of hypovolaemia during acute haemorrhage
- Whole blood or red blood cells are indicated when blood loss is >20- 30% of blood volume (>15-20 mL/kg)
- The need for blood must be determined by:
- Amount and speed of blood loss
- Patient’s critical signs
- Initial response to IV fluid resuscitation
- Hb level is NOT a reliable indicator for blood need in acute haemorrhage
Sickle cell anaemia
- Blood transfusion is not necessary for asymptomatic sickle cell patient with steady Hb 6-8 g/dL
- Blood transfusion is indicated if:
- Acute severe anaemia (Hb <5 g/dL or 2 g/dL lower than usual level for the patient) in aplastic and sequestration crisis. Aim at Hb 7-8 g/dL
- Hb <6 g/dL in uncomplicated pregnancy
- Hb <8 g/dL if caesarean section
- Hb <9 g/dL in case of acute chest syndrome, and stroke
- Use packed cells: whole blood is indicated in acute hemorrhage only
Neonatal conditions
- Severe unconjugated hyperbilirubinaemia
- Severe anaemia of any cause (prematurity, sepsis, etc.)
- Transfusion in neonates should be managed at specialist level