Blood Transfusion

Patients with massive bleeding should be transfused with blood, platelets and clotting factors in line with local protocols. Decisions to transfuse should be based on the full clinical picture, recognising that over-transfusion may be harmful. In more stable patients, transfusion targets can be used.

NICE guidelines recommend the following:

• Red blood cell transfusion if Hb < 70g/L
• Platelet transfusion in those who are actively bleeding with platelet count of less than 50 x 10⁹/L
• Fresh frozen plasma in those who are actively bleeding with a prothrombin time, INR, or activated partial thromboplastin time (APTT) greater than 1.5 times normal
• Cryoprecipitate in patients with fibrinogen <1.5g/L despite FFP transfusion

Ensure reversal of anticoagulation agents is considered

• Use prothrombin complex concentrate (and vitamin K) for patients who are taking warfarin and are actively bleeding
• Andexanet alfa is recommended as an option for reversing anticoagulation from apixaban or rivaroxaban in adults with life-threatening or uncontrolled GI bleeding [1]

Thromboelastography can also be used, if available, to guide transfusion of clotting products.