Bedside Snapshot
- Use It For
- Hemorrhage with shock or significant anemia; massive transfusion; bleeding from multiple factor loss (DIC, liver disease, warfarin: vitamin K plus 4F-PCC); bleeding or procedures with low platelets
- Adult Dose
- RBC: 1 unit, then reassess (1 unit raises Hgb about 1 g/dL)
- Plasma: about 15 mL/kg, guided by INR or viscoelastic results
- Platelets: 1 apheresis unit (3 × 10¹¹ platelets)
- Pediatric Dose
- RBC and plasma 10–15 mL/kg; platelets 5–10 mL/kg or 1 unit per 10 kg; cryoprecipitate 1–2 units per 10 kg. Actual weight; no fixed max; reassess after each product
- Onset / Duration
- IV: effect during infusion. Platelet count rises 30,000–60,000/µL 1 hr after an apheresis unit; transfused platelets survive 3–4 days
- Do Not Give / Hold If
- Plasma for INR 1.7 or less without bleeding; platelets for nonoperative ICH with count above 100,000/µL, including antiplatelet use; red cells for stable Hgb 7 g/dL or above
- Watch For
- Acute hemolytic reaction (fever, hypotension, hemoglobinuria); TACO (dyspnea, volume overload); TRALI within 6 hr; ionized hypocalcemia and hypothermia with rapid large volumes; allergic and anaphylactic reactions
- Reversal / Rescue
- No antidote: stop the transfusion, keep the IV open with 0.9% sodium chloride, notify the blood bank, return the bag and samples. Anaphylaxis: epinephrine and supportive care
- Must Remember
- Transfuse the patient, not the number: Hgb triggers apply to stable patients. In hemorrhage, transfuse for shock and bleeding, and check two identifiers and ABO at the bedside
Indications
Emergency & Prehospital
- Hemorrhagic shock from trauma: red cells with plasma and platelets per protocol. In the air-medical PAMPer trial, prehospital plasma improved 30-day mortality. Ground-ambulance COMBAT showed no clear overall survival benefit. A post hoc analysis of PAMPer and COMBAT found a survival association when transport took longer than 20 minutes. UK RePHILL (prehospital red cells with lyophilized plasma) was not superior to saline. Protocols vary
- Massive transfusion: the ratio is fixed, usually 1:1:1 for plasma, platelets and red cells (PROPPR trial). The protocol sets the pace, not the lab. Check ionized calcium and replace it per protocol (calcium chloride). Give tranexamic acid early per protocol. Some systems use early whole blood where it is available. Viscoelastic testing can guide plasma and platelet use
- Life-threatening hemorrhage before typing: uncrossmatched group O red cells when delay would be fatal. Under blood bank policy, low-titer group O whole blood (tested for anti-A and anti-B, where the blood bank supplies it) or group O red cells with group A or AB plasma may be given as initial resuscitation before the recipient group is known
ED / ICU / Transport
- Red cells, stable adults: the trigger is hemoglobin below 7 g/dL in hospitalized, hemodynamically stable adults (strong recommendation under the AABB 2023 guideline). Clinicians may use 7.5 g/dL after cardiac surgery and 8 g/dL after orthopedic surgery or with preexisting cardiovascular disease
- Red cells, acute myocardial infarction: AABB 2025 suggests a liberal strategy, transfusing below 10 g/dL (conditional, low-certainty evidence). A restrictive 7–8 g/dL strategy may increase mortality in AMI. The threshold here differs from the stable-adult one
- Red cells, critically ill children: the restrictive threshold is 7 g/dL when the child is hemodynamically stable and has no hemoglobinopathy, cyanotic heart disease or severe hypoxemia (AABB 2023 guideline)
- Plasma: bleeding or a procedure with several factor deficiencies (liver disease, DIC). Massive transfusion with clinically significant coagulopathy also qualifies. For bleeding on warfarin, vitamin K plus 4-factor prothrombin complex concentrate (PCC) is preferred for urgent or major bleeding. Plasma is used only if PCC is unavailable. TTP plasma exchange or transfusion (Circular of Information)
- Platelets, prophylactic count thresholds under the AABB 2025 guideline. Strong recommendations: below 10 × 10³/µL in nonbleeding hypoproliferative thrombocytopenia from chemotherapy or allogeneic stem cell transplant; below 25 × 10³/µL in neonates with consumptive thrombocytopenia without major bleeding; below 20 × 10³/µL before lumbar puncture. Conditional recommendations: below 10 × 10³/µL with consumptive thrombocytopenia and for central venous catheter placement at a compressible site; below 20 × 10³/µL for low-risk and below 50 × 10³/µL for high-risk interventional radiology; below 50 × 10³/µL before major nonneuraxial surgery. Prophylactic transfusion is not recommended for nonbleeding hypoproliferative thrombocytopenia after autologous stem cell transplant or in aplastic anemia
Not Indicated
- Platelets for nonoperative intracranial hemorrhage, including with antiplatelet drugs and a count above 100 × 10³/µL: not recommended under the AABB 2025 guideline. The PATCH trial found harm. See Clinical Pearls
- Plasma to correct a minimally elevated INR (1.7 or less) without bleeding. Plasma for volume expansion is not indicated either
Composition
Blood components are not one drug. This section lists what each product contains. The volumes are typical values from the Circular of Information. Each unit's label gives the actual volume.
| Product | What It Contains | Typical Volume | Expected Effect (adult) |
|---|---|---|---|
| Red blood cells (RBC) | Red cells with a hematocrit of 65–80% (unadditive) or 55–65% (additive solution) | 225–350 mL (unadditive); 300–400 mL (additive solution) | About 1 g/dL Hgb (about 3% Hct) per unit |
| Plasma (fresh frozen, thawed, liquid) | All coagulation factors at near-normal levels (fresh frozen); some factors reduced (thawed); liquid plasma from whole blood | 200–250 mL on average; apheresis units 400–600 mL | Factor levels rise (about 15–20% per 10–15 mL/kg in children) |
| Platelets | Apheresis: 3 × 10¹¹ platelets; whole-blood-derived: 5.5 × 10¹⁰ platelets in 40–70 mL | Apheresis: 250–300 mL; six whole-blood units equal one apheresis unit | 30,000–60,000/µL at 1 hr (apheresis) |
| Cryoprecipitate (cryo) | At least 150 mg fibrinogen and 80 units factor VIII per unit, plus factor XIII and von Willebrand factor | Varies; up to about 15 mL per unit | Fibrinogen rises 60–100 mg/dL per 1–2 units per 10 kg (children) |
- Plasma adds volume without oxygen: it does not raise oxygen-carrying capacity. Pick each product for the deficit it fixes, not for the volume it adds.
- Cryo and fibrinogen concentrate are covered on the Fibrinogen page. Dosing here is only a cross-reference.
Dosing & Administration
Doses vary by protocol; follow local protocols and medical direction. Products are ordered by component, not by milligrams. The blood bank supplies compatible units. At the bedside, you verify identity.
Available Forms
- Red cells: unadditive (225–350 mL) or additive solution (AS-1, AS-3, AS-5; 300–400 mL; 42-day shelf life at 1–6 °C)
- Plasma: fresh frozen (stored at –18 °C or colder; thaw in a 30–37 °C water bath or cleared thawer); thawed plasma; liquid plasma (1–6 °C, expires 5 days after the whole-blood dating period)
- Platelets: apheresis (single donor, 3 × 10¹¹ platelets) or whole-blood-derived (about six units equal one apheresis unit); both stored at 20–24 °C with gentle agitation
- Cryoprecipitate: pooled units from plasma; stored frozen, thawed by the blood bank (see Fibrinogen page)
Product Identification Check: Before the first drop, check the wristband and the unit tag. Name, date of birth and medical record number have to match. So do the unit number, ABO group and expiration time. Chart it by component, never as "blood" or "units".
Adult Dosing
| Indication | Dose & Route | Repeat / Max | Notes |
|---|---|---|---|
| Anemia or hemorrhage: red cells | 1 unit RBC, reassess; IV | Reassess Hgb and bleeding after each unit; no fixed max | Expect about 1 g/dL rise per unit in a stable average adult; a smaller rise means ongoing loss |
| Coagulopathy with bleeding: plasma | About 15 mL/kg IV (actual weight) | No fixed max: guide by INR, fibrinogen or viscoelastic results | INR 1.5–1.7 keeps at least 30% factor activity; a standard plasma dose may not normalize an INR of 1.7 or less |
| Massive transfusion (trauma) | Plasma, platelets and red cells in a fixed ratio, usually 1:1:1, IV | Per protocol; reassess after each pack; no fixed max | PROPPR: no significant difference in 24-hr or 30-day mortality versus 1:1:2; exsanguination was lower with 1:1:1 |
| Thrombocytopenia with bleeding or procedure: platelets | 1 apheresis unit (3 × 10¹¹) IV | Recount 1 hr after; repeat per count and bleeding; no fixed max | Short life span (3–4 days): prophylactic doses may need repeating in 1–3 days; not for nonoperative ICH above 100 × 10³/µL |
Pediatric Dosing
| Indication | Dose (per kg) & Route | Max Single / Max Total | Notes |
|---|---|---|---|
| Red cells (AS) | 10–15 mL/kg IV | No fixed max: volume by weight | Expected rise about 2 g/dL. Washed red cells 10–15 mL/kg, rise about 3 g/dL |
| Plasma | 10–15 mL/kg IV | No fixed max: guide by labs | Expected factor rise 15–20% (ideal recovery assumed) |
| Platelets (whole-blood-derived) | 5–10 mL/kg IV, or 1 unit per 10 kg (patients over 10 kg) | No fixed max: recount | Expected rise 50,000–100,000/µL. Use ABO-compatible plasma in small children |
| Cryoprecipitate | 1–2 units per 10 kg IV (or 2–3 mL/kg) | No fixed max: replace for measured low fibrinogen | Expected rise 60–100 mg/dL. Unit volume varies (up to about 15 mL) |
Neonates and small children: smaller aliquots are an option for neonatal and pediatric patients, according to the Circular of Information. For these patients, run pediatric hemotherapy protocols with specialist input. See Weight-Based Dosing.
Preparation & Administration
- Compatibility: red cells must be ABO-compatible with the recipient's plasma. Use uncrossmatched group O red cells only when delay would be life-threatening. Plasma must be ABO-compatible with the recipient's red cells. Routine platelets need no compatibility testing
- Thawing plasma: thaw in a 30–37 °C water bath in a protective overwrap with gentle agitation, or in an FDA-cleared thawer. Infuse fresh frozen plasma right after thawing, or hold it at 1–6 °C. After 24 hours it must be discarded or relabeled as thawed plasma
- Start slowly: run the first portion of each unit cautiously and watch closely for acute reactions. Speed up as the circulation tolerates it
- Time limit: red-cell components should not sit at room temperature longer than 4 hours. If the infusion has to run slower than 4 hours, order smaller aliquots
- Line: use a standard blood set. Nothing else goes through the line except 0.9% sodium chloride, unless the product or drug is documented safe. Never run lactated Ringer's or another calcium-containing solution through tubing with citrated blood
- Platelets: hold conventional room-temperature platelets at 20–24 °C with agitation until transfusion. Do not refrigerate them unless the blood bank supplies cold-stored platelets, which follow its labeling
Dosing Notes: These Hgb targets and product numbers trace to the AABB 2023 and 2025 guidelines and the Circular of Information. A number never beats the patient in front of you. Active bleeding, individual decisions and local blood bank policy all override any number on this page.
Contraindications & Precautions
Contraindications
- Coagulopathy that a specific therapy corrects better. Vitamin K plus 4F-PCC for urgent VKA reversal, cryoprecipitate or fibrinogen concentrate for low fibrinogen, or a specific factor concentrate (Circular of Information)
- Plasma for volume expansion alone. Other volume expanders can replace blood volume
- Platelets for nonoperative intracranial hemorrhage with a count above 100 × 10³/µL, including antiplatelet use under the AABB 2025 guideline
- A prior severe transfusion reaction to the same product, or a known antibody that makes the unit incompatible. The blood bank decides
Precautions
- Chronic severe anemia, heart or kidney disease, the very young and the elderly: these patients carry a high risk of TACO. Transfuse slowly and reassess after each unit
- IgA deficiency with anti-IgA antibodies: the risk is anaphylactic reactions. Washed products may be used (Circular of Information)
- Rh(D)-negative recipients: Rh(D)-positive platelets are common in Rh(D)-negative patients. The risk is higher with whole-blood-derived platelets and very low with apheresis platelets (Circular of Information)
- TTP and HIT: platelet transfusion is generally avoided unless bleeding is life-threatening. Involve hematology
- Immunocompromised and at-risk recipients: irradiated cellular components prevent transfusion-associated GVHD. They go to intrauterine transfusion recipients, selected immunocompromised patients (such as transplant recipients or those on alemtuzumab or antithymocyte globulin), HLA-selected donor components, and components from a blood relative. When the order requires it, transport teams should confirm the label says Irradiated. CMV-seronegative or prestorage leukocyte-reduced components go to at-risk CMV-seronegative recipients, including pregnant women and fetuses, low-birthweight infants, transplant recipients, severely immunosuppressed patients and patients with HIV (Circular of Information)
- Massive or rapid transfusion: watch for citrate-related hypocalcemia, hypothermia and coagulopathy from dilution. Check ionized calcium and warm products per protocol
Hold / Reassess If
- Fever of 1 °C (1.8 °F) or more, chills, hypotension, hemoglobinuria or chest or flank pain: stop the transfusion (acute reaction)
- New hypoxemia or dyspnea: stop and evaluate for TACO (usually within 6 hr; some definitions allow up to 12 hr) or TRALI (within 6 hr)
- Stable Hgb 7 g/dL or above in an adult with no bleeding: reassess the need for red cells
- INR 1.7 or less without bleeding: reassess the need for plasma
Stop the Bag, Keep the Line: Any suspected reaction means you stop the infusion, keep the IV open with 0.9% sodium chloride and notify the blood bank right away. Hold the bag and tubing. Send samples the way the blood bank directs.
Adverse Effects & Toxicity
Common
- Febrile non-hemolytic reactions: a temperature rise of 1 °C (1.8 °F) or more, or chills, during or within 4 hours of transfusion. Usually less than 1% with leukoreduced red cells
- Mild allergic reactions: urticaria, itching, flushing
- Bleeding or bruising at the puncture site
Serious / Life-Threatening
| Effect | Recognition | Management |
|---|---|---|
| Acute hemolytic reaction | Fever, chills, hypotension, hemoglobinuria, back or chest pain, bleeding (DIC); in anesthetized patients, hemoglobinuria, hypotension or DIC may be the first signs | Stop the transfusion; keep the IV open; blood bank and direct antiglobulin test; support blood pressure and kidneys per protocol |
| Transfusion-associated circulatory overload (TACO) | New or worse respiratory distress, rales, raised venous pressure, radiographic edema; onset usually within 6 hr after transfusion; some definitions allow up to 12 hr | Stop; sit up; oxygen; diuretic per protocol; limit colloid including plasma; reassess the need before restarting |
| Transfusion-related acute lung injury (TRALI) | Acute hypoxemia and noncardiogenic pulmonary edema within 6 hr | Stop; aggressive respiratory support, often mechanical ventilation; report to the blood bank at once |
| Anaphylactoid or anaphylactic reaction | Hypotension, tachycardia, bronchospasm, laryngeal edema (rare, under 10 per 100,000 units) | Stop; epinephrine IM and supportive care per protocol; washed products for future units |
| Ionized hypocalcemia | Tremor, paresthesia, hypotension, arrhythmia after rapid large volumes, especially with liver failure or shock | Check ionized calcium or ECG; replace calcium per protocol (calcium chloride) |
| Hyperkalemia | Peaked T waves, arrhythmia or weakness; risk with rapid or massive transfusion of stored red cells, and in neonates, small children and exchange transfusion | Check potassium and ECG; treat per protocol (potassium); for neonates and rapid infusion, use fresher units or remove residual supernatant |
| Hypothermia | Shivering, arrhythmia, worsening coagulopathy after rapid cold product | Warm products and patient; monitor rhythm |
| Infection | Fever, rigors, hypotension during or after transfusion, especially platelets | Stop; cultures; blood bank investigation (bacterial risk controls for platelets) |
| Delayed hemolytic reaction | Usually 2–14 days after transfusion in a patient with prior red-cell alloantibodies: unexplained fever, falling hemoglobin, positive direct antiglobulin test, raised bilirubin or LDH | Blood bank evaluation; most have a benign course and need no treatment |
| Transfusion-associated graft-vs-host disease (TA-GVHD) | Fever, rash, diarrhea, liver dysfunction and pancytopenia after transfusion of viable donor T lymphocytes; rare but nearly always fatal | Prevention is key: irradiated cellular components for at-risk recipients; urgent hematology care and blood bank report |
Overdose & Toxicity Management
- Volume overload: stop the product, sit the patient up, and give oxygen and a diuretic per protocol. Use the fewest plasma units that meet the need
- Reaction workup: the blood bank works up the unit, the patient sample and the direct antiglobulin test. Report every suspected reaction
Monitoring
| Parameter | When / How Often | Target / Act If |
|---|---|---|
| Clinical: vitals and reaction signs | Slow start, then at intervals and at the end of each unit | Fever of 1 °C or more, chills, hypotension, hemoglobinuria: stop and notify the blood bank |
| Clinical: breathing and oxygenation | Throughout and for 6 hr after (TRALI and TACO usually within 6 hr; some TACO definitions allow 12 hr) | New hypoxemia or dyspnea: stop; evaluate for TACO or TRALI |
| Laboratory: hemoglobin / hematocrit | After each red-cell unit or per protocol (hemoglobin) | Expected rise about 1 g/dL per unit in a stable adult; a smaller rise means ongoing bleeding or hemolysis: investigate |
| Laboratory: ionized calcium | During massive or rapid transfusion, per protocol (calcium) | Low ionized calcium or ECG change: replace per protocol. Total serum calcium does not reliably show this |
| Laboratory: platelet count | One hour after an apheresis unit (platelets) | Expected rise 30,000–60,000/µL; a poor rise suggests consumption, bleeding or refractoriness |
| Laboratory: PT/INR, fibrinogen, viscoelastic tests | Per protocol during bleeding (PT/INR; fibrinogen) | Low fibrinogen: cryo or concentrate; INR 1.7 or less without bleeding: plasma is unlikely to normalize it |
| Temperature | Continuous during rapid or large-volume transfusion | Hypothermia: warm products and patient; monitor rhythm |
Interactions & Compatibility
Clinically Significant Interactions
| Drug / Class | Effect | What To Do |
|---|---|---|
| Citrate (anticoagulant in every unit) | Ionized calcium falls with rapid large volumes; liver failure or shock slows citrate clearance | Check ionized calcium or ECG; replace calcium per protocol |
| Lactated Ringer's and other calcium-containing solutions | Calcium with citrated blood can clot the line | Never run through the same tubing as blood components |
| Vitamin K antagonists (warfarin) | Plasma gives only partial, transient reversal in a large volume; 4F-PCC acts faster with less volume; vitamin K acts over hours | |
| Antiplatelet drugs (aspirin, clopidogrel) with intracranial bleeding | Platelet transfusion does not help and may harm (PATCH) | Do not give platelets for nonoperative ICH with a count above 100 × 10³/µL |
| Antifibrinolytics (tranexamic acid) | Used for bleeding alongside products; not a substitute for them | Give per protocol (tranexamic acid) |
| Low-fibrinogen bleeding | Plasma has low, variable fibrinogen content | Use cryo or fibrinogen concentrate (fibrinogen) |
| Rh(D)-negative recipient receiving Rh(D)-positive platelets | Alloimmunization risk, higher with whole-blood-derived platelets | Blood bank decides on Rh immune globulin (Rh immune globulin) |
IV Compatibility
- Dedicated line: the only fluid that goes with blood components is 0.9% sodium chloride. Do not add medications unless they are documented safe (Circular of Information)
- Calcium-containing solutions: keep them away from citrated blood (see table above)
- Hypotonic solutions and dextrose: hypotonic fluids in the line can cause nonimmunologic hemolysis (Circular of Information). Do not run them with blood components
- Check with an institutional compatibility resource and the blood bank.
Special Populations
- Pediatrics: doses are weight-based, so see the Pediatric Dosing table. Use smaller aliquots when needed. Neonatal and small-child products need specialist and blood bank input. Pediatric massive transfusion follows pediatric hemotherapy protocols
- Neonates: use smaller aliquots. Give ABO-compatible plasma for small blood volumes. Follow pediatric hemotherapy protocols
- Pregnancy: no product-specific restriction in the standard. For postpartum hemorrhage, follow obstetric protocols. Early fibrinogen replacement (fibrinogen) and tranexamic acid are commonly part of these protocols. For Rh(D)-negative patients, see Interactions for Rh immune globulin
- Lactation: no specific adjustment established
- Older Adults: the risk of TACO is higher. Transfuse slowly and reassess after each unit (Circular of Information)
- Renal Impairment: underlying renal disease raises the risk of circulatory overload (Circular of Information). No specific dose change is established. Reassess volume after each unit
- Hepatic Impairment: citrate clearance drops, so rapid large-volume transfusion carries a higher risk of hypocalcemia (Circular of Information)
- Obesity / Dosing Weight: adult red-cell and platelet doses are fixed units. mL/kg doses use actual body weight unless the protocol says otherwise
- Immunocompromised and transplant patients: irradiated and CMV-safe cellular components may be required. See Precautions
- Refusal and consent: obtain informed consent per policy. Patients who decline blood or specific components (for example, Jehovah's Witnesses) are managed by their documented wishes, blood-conservation measures and the treating team's decision, with blood bank input
Field & Transport Considerations
- Scope: prehospital blood and plasma are given in some systems, under a protocol and medical oversight, usually for trauma. Critical-care transport teams continue products started in the hospital. It varies by state and agency protocol.
- Storage & Stability: red cells stay at 1–6 °C. Conventional room-temperature platelets stay at 20–24 °C with agitation (never refrigerated. Cold-stored platelets follow blood-bank labeling). Frozen plasma stays at –18 °C or colder until thawed. Thawed plasma stays at 1–6 °C. Use a blood-bank-approved transport container and keep products out of hot or freezing vehicle compartments.
- Carried Product: identify each unit by component type, unit number, ABO group and expiration time. Never by strength. Never swap one component for another at handoff.
- Infusions in Transport: hang the unit on a standard blood set with a dedicated line. Watch for reactions in the first minutes, and for TACO or hypocalcemia during rapid infusion. Platelets need agitation until the moment they are transfused.
- Handoff Essentials: product types and unit numbers, time started and expected finish, volume given, reactions, pre-transfusion and latest Hgb, platelet count, INR or fibrinogen if available, and what protocol the team is following.
Clinical Pearls
Plasma Is Not for an INR of 1.7 or Less: a standard plasma dose (about 15 mL/kg) may not normalize an INR of 1.7 or less when no one is bleeding. An INR of 1.5 to 1.7 still reflects at least 30% factor activity. Name the reason before you order plasma.
Platelets Can Harm in Antiplatelet ICH: the PATCH trial gave platelets within 90 minutes of imaging for spontaneous ICH on antiplatelet therapy. The result was higher odds of death or dependence at 3 months (adjusted OR 2.05). AABB 2025 does not recommend the practice.
One Unit, About 1 g/dL: that rise is for a stable average adult. During active bleeding, Hgb trails the real loss. So do not wait for a number before you transfuse.
Exam Discriminator: Threshold by Setting: the threshold depends on the setting. Stable hospitalized adults get 7 g/dL (8 with preexisting heart disease). Acute MI uses 10 g/dL (AABB 2025 liberal strategy). In hemorrhagic shock, you transfuse for bleeding and perfusion, not for a number.
Serum Calcium Misleads: total calcium cannot tell ionized from complexed calcium. During massive transfusion, the change that matters shows up on ionized calcium or ECG monitoring.
Group O Red Cells in Emergencies: if delay would be life-threatening, uncrossmatched group O red cells may be given. Where the blood bank supplies it, low-titer group O whole blood (tested for anti-A and anti-B) is an option for starting resuscitation before typing. If red cells go in before typing, pair them with group A or AB plasma.
Platelets Stay at Room Temperature: the storage is 20–24 °C with gentle agitation. Expiration is 5, 6 or 7 days, depending on the bacterial testing strategy. Until transfusion, hold conventional room-temperature platelets at that temperature. Do not refrigerate them unless the blood bank has issued cold-stored platelets under its labeling.
Pharmacology
Mechanism of Action
- Red cells: they carry hemoglobin and restore oxygen-carrying capacity. They do not expand volume, so do not give them for that purpose
- Plasma: it supplies coagulation factors, including factor II and fibrinogen, plus other plasma proteins. That corrects multiple factor deficits
- Platelets: they give a surface for clot formation at a bleeding site. Donor platelets have a short life span
- Cryoprecipitate: it concentrates fibrinogen, factor VIII, factor XIII and von Willebrand factor (see Fibrinogen page)
Pharmacokinetics
- Red cells: about 1 g/dL Hgb per unit in an average-sized adult. Children get smaller aliquots
- Platelets: an apheresis unit raises the count by 30,000–60,000/µL at 1 hr. A whole-blood-derived unit raises a 70-kg adult count by 5,000–10,000/µL. Transfused platelets survive 3–4 days
- Plasma: fresh frozen plasma has near-normal factor levels. Thawed plasma keeps factor II and fibrinogen at levels clinically similar to fresh frozen plasma, and other factors are variably reduced
- Elimination: the liver metabolizes citrate. A recipient immune response can destroy incompatible transfused cells
Names & Classification
- Generic Name
- Packed red blood cells (red cell concentrate); fresh frozen plasma; thawed plasma; liquid plasma; apheresis and whole-blood-derived platelets; cryoprecipitated antihemophilic factor
- Brand Names
- None; blood-bank product labels and additive solutions (AS-1, AS-3, AS-5)
- Pharmacologic Class
- Allogeneic human blood components
- Therapeutic Class
- Hematologic replacement
- Controlled Substance
- Not controlled
- ISMP High-Alert
- No; blood components follow blood-bank transfusion safety procedures
- Look-Alike / Sound-Alike
- Plasma and platelets (orders by component); thawed plasma and fresh frozen plasma; cryoprecipitate and cryoprecipitate-reduced plasma
- Error-Prone Abbreviations to Avoid
- "U" for units; "FFP" and "PRBC" are common but write the component name at ordering
References
- Carson JL, et al. (2023). Red blood cell transfusion: 2023 AABB International Guidelines. JAMA, 330(19), 1892–1902. https://doi.org/10.1001/jama.2023.12914
- Pagano MB, et al. (2025). Red cell transfusion in acute myocardial infarction: AABB International Clinical Practice Guidelines. Annals of Internal Medicine, 178, 1469–1477. https://doi.org/10.7326/ANNALS-25-00706
- Metcalf RA, et al. (2025). Platelet transfusion: 2025 AABB and ICTMG International Clinical Practice Guidelines. JAMA, 334, 606–617. https://doi.org/10.1001/jama.2025.7529
- AABB, America's Blood Centers, American Red Cross and Armed Services Blood Program (2024). Circular of Information for the Use of Human Blood and Blood Components (June 2024). Includes the pediatric dosing table (Table 3), storage, and reaction definitions. https://www.aabb.org/news-resources/resources/circular-of-information
- Holcomb JB, et al. (2015). Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA, 313, 471–482 (landmark trial). https://doi.org/10.1001/jama.2015.12
- Sperry JL, et al. (2018). Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock (PAMPer). New England Journal of Medicine, 379, 315–326 (landmark trial). https://doi.org/10.1056/NEJMoa1802345
- Baharoglu MI, et al. (2016). Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet, 387, 2605–2613 (landmark trial). https://doi.org/10.1016/S0140-6736(16)30392-0
- Pusateri AE, et al. (2020). Association of prehospital plasma transfusion with survival in trauma patients with hemorrhagic shock when transport times are longer than 20 minutes: a post hoc analysis of the PAMPer and COMBAT clinical trials. JAMA Surgery, 155, e195085. https://doi.org/10.1001/jamasurg.2019.5085
- Crombie N, et al. (2022). Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Haematology, 9, e250–e261. https://doi.org/10.1016/S2352-3026(22)00040-0
- Tomaselli GF, Mahaffey KW, Cuker A, et al. (2020). 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants. Journal of the American College of Cardiology, 76(5), 594–622. https://doi.org/10.1016/j.jacc.2020.04.053
- Sarode R, Milling TJ Jr, Refaai MA, et al. (2013). Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding (randomized, plasma-controlled trial). Circulation, 128, 1234–1243. https://doi.org/10.1161/CIRCULATIONAHA.113.002283
- Vlaar APJ, Toy P, Fung M, Looney MR, et al. (2019). A consensus redefinition of transfusion-related acute lung injury. Transfusion, 59(7), 2465–2476. https://doi.org/10.1111/trf.15311
Medical Disclaimer
- For Educational Purposes Only: This content is intended for educational reference and should not be used for clinical decision-making.
- Not a Substitute for Professional Judgment: Always consult your local protocols, institutional guidelines, and supervising physicians.
- Verify Before Acting: Users are responsible for verifying information through authoritative sources before any clinical application.
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