Protocols - Hemorio

TRANSFUSION OF RED BLOOD CELLS, PLATELETS, FROZEN FRESH PLASMA AND GENERAL
INDICATIONS
GENERAL INDICATIONS
1 – CONCENTRATE OF RED BLOOD CELLS: In hematological subjects, as in any other subject, the
transfusion of red blood cells is seldom indicated when the hemoglobin is above 10g%, and almost all the
time the transfusion must be done when the hemoglobin is below 6g%.
The exceptions to this general rule must be established from the evaluation of the subject and its tolerance
and adaptation to the anemia.
The transfusion of the red blood cells concentrate at HEMORIO is always done with de-leukocytal
components (pre-stock de-leukocytization or bench), never in bed.
2 – PLATELETS TRANSFUSION:
PROPHYLACTIC TRANSFUSION:
Aplasias of post-chemotherapy and/or post-radiotherapy marrow (including the Bone Marrow
Transplantation): The prophylactic transfusion of platelets is indicated whenever the platelets counting
falls below 10,000/mL. In subjects that present risk factors for hemorrhages such as big splenomegaly,
fever, usage of antibiotics and/or antifungal, this trigger may be higher (15,000 or up to 20,000
platelets/µL).
Thrombocytopenia of the Aplastic Anemias and Myelodysplastic Syndrome (MDS): It is
recommended the adoption of the trigger of 5,000 platelets/µL in subjects with aplastic anemia or MDS
stable, and triggers of 10,000 platelets/µL for subjects with fever, infections or usage of antibiotics /
antifungal.
Thrombocytopenic Subjects that will undergo surgeries or invasive procedures: It is recommended
the prophylactic transfusion of platelets whenever the counting is below 50,000/µL at the following
situations: Peridural anesthesia / Transbroncheal biopsy / Hepatic biopsy / Laparotomy / Puncture of deep
veins / Paracentesis and thoracocentesis / Dental extraction / Gastric biopsy (endoscopic).
In neurological and ophthalmologic surgeries, it is recommended that the counting of platelets is around
100,000/µL.
At the cardiac surgeries with extra-body circulation, there is not a consensus in the literature on the
minimum counting of 50,000 or 100,000/µL.
In all the cases above, it is recommended the prophylactic transfusion of platelets immediately before the
procedures.
On the biopsies procedures of bone marrow, lumbar puncture and bronchoscopy (with no biopsy), the
platelets counting must be above 20,000/µL.
There is no indication of platelets prophylactic transfusion at the IDIOPATHIC
THROMBOCYTOPENIC PURPURA (ITP): At the preparation for splenectomy, it is recommended not to
transfuse prophylactically before the surgery, but keep two (2) doses of platelets concentrates - CP, which
will be used in the course of the surgical act, if there is any important bleeding.
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