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Quick Tip for Families in Intensive Care: When Should Blood Transfusions Be Given in Intensive Care?

“When should blood transfusions be given in intensive care?” That is a question we get quite frequently here at intensivecarehotline.com.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

So, in ICU or in intensive care units, blood transfusions are given based on clinical need and are guided by evidence-based thresholds. I’ll give you an overview today when blood transfusions are typically indicated in ICU patients.

Let’s start with red blood cell (RBC) transfusions. They are indicated when hemoglobin, which are the red blood cells, is less than 7 g/dL in most critically ill patients without active bleeding or significant cardiac disease. This is supported by the landmark TRICC trial (Transfusion Requirements in Critical Care)

Then, hemoglobin less than 8 g/dL in patients with acute coronary artery disease, patients undergoing major surgery or septic shock with evidence of tissue hypoxia because especially the heart has a high oxygen demand. But also, as soon as there’s a low hemoglobin, not all organs and tissue might get the oxygen they need to perform at its best.

Acute blood loss, anemia with signs of inadequate oxygen delivery, tachycardia, hypotension, low urine output, or lactic acidosis despite fluid resuscitation. Tachycardia means fast heart rate, because the heart is compensating for not having enough fluids and hypotension means low blood pressure.

Next, let’s look at platelet transfusion. They are indicated when platelet count is less than 10,000/?L to prevent spontaneous bleeding. The platelets are in your blood to stop the blood from bleeding. So, if your platelet count is low, a spontaneous bleed is much more likely. Therefore, platelet transfusion is often given, once again, to prevent spontaneous bleeding. If platelet count is less than 20,000/?L, if the patient has fever or is at higher risk of bleeding. If platelet count is less than 50,000/?L, if an invasive procedure or surgery is scheduled and active bleeding is present.

The next blood transfusion that can be given in intensive case is plasma, also known as fresh frozen plasma (FFP) and it’s indicated when INR (International Normalized Ratio), PT (Prothrombin Time) or PTT (Partial Thromboplastin Time) with active bleeding is prevalent or prior to invasive procedures. If there is coagulopathy due to liver failure, DIC, which stands for disseminated intravascular coagulation, massive transfusion requiring correction of clotting factors. Coagulopathy is basically a condition where the blood’s ability to clot is impaired leading to excessive bleeding or abnormal clot formation. FFPs can also be given for plasma exchange in certain conditions.

Next, cryoprecipitate is indicated when fibrinogen is less than 1.5 g/dL in bleeding patients or in DIC, once again, disseminated intravascular coagulation, massive transfusion or liver disease with low fibrinogen.

Next, there are massive transfusion protocols in ICU which are triggered when there’s an ongoing massive hemorrhage, often defined as 10 units of red blood cells in 24 hours, 4 units in 1 hour with anticipated need for more. This I’ve seen many times in ICU after multi-trauma, when patients come in to the ICU and are bleeding heavily.

What are other considerations for blood transfusions in intensive care? Individualized decisions, consider clinical contexts, comorbidities, cardiac disease, and physiological signs of poor perfusion, risks of transfusion include transfusion-related acute lung injury, infections, volume overload, and immunological reactions.

So, that sums it up. I hope that answers this question that we get quite frequently.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that by looking at our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews.

Because our advice is absolutely life changing, when families work with us one on one, you know, we change their lives, we improve their lives instantly because our insights are invaluable.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. That is exactly what we are helping with to improve your life instantly so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

You can join a growing number of members and clients that we have helped over the years. That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you can’t afford to get wrong. When I talk to you and your families directly, I also talk to doctors and nurses, case managers, social workers, nurse practitioners, whoever you want me to talk to and ask all the questions that you haven’t even considered asking, but must be asked when you have a loved one critically ill in intensive care.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

I also represent you in family meetings with intensive care teams.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. As a member, you have exclusive access to 21 e-books and 21 videos that are only exclusively accessible for our members.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, families and comment below what you want to see next, what questions and insights you have and share the video with your friends and families, or with anybody that has a loved one in intensive care.

I also do a weekly YouTube live where I answer your questions live on a show. You will get notification for the YouTube live if you are a subscriber to my email newsletter at intensivecarehotline.com or if you are a subscriber to my intensivecarehotline.com YouTube channel.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.

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