Knowledge Base

Blood Transfusion

Knowledge Base

title: "Blood Transfusion"

Blood Transfusion

Key Facts

In most acute upper GI bleeding, use a restrictive strategy: transfuse PRBCs when Hb <70 g/L and target 70–90 g/L.

Source: local transfusion guideline.

In suspected variceal bleeding, avoid over-transfusion because it can increase portal pressure and worsen rebleeding risk.

Massive transfusion protocols (e.g., 1:1:1) are for exsanguinating haemorrhage, not routine hematemesis.

Overview

This article covers practical transfusion thresholds and common ED pitfalls (GI bleed vs massive haemorrhage).

PRBC transfusion thresholds (high level)

  • Stable GI bleed: transfuse when Hb <70 g/L (target 70–90)
  • Higher threshold may be reasonable (often Hb <80 g/L) in active myocardial ischaemia, significant cardiovascular disease, or ongoing shock

Plasma and platelets (common pitfalls)

  • Mild INR elevation (e.g. ~1.4) alone does not mandate FFP
  • Focus on haemostasis, source control, and patient physiology

Exsanguinating haemorrhage (different problem)

  • Hb can be misleading early in acute blood loss (it may not fall immediately)
  • Transfusion decisions are driven by physiology (shock, ongoing bleeding, lactate/base deficit, response to resuscitation)
  • Activate massive transfusion protocols for uncontrolled haemorrhage/shock, not stable hematemesis

Sources

  • CC Bible
  • Local transfusion guidelines

Test Your Knowledge

SBAeasyTransfusionBlood ProductsGI bleeding
A haemodynamically stable patient with acute upper GI (Gastrointestinal) bleeding has Hb (Haemoglobin) 76 g/L. What is the best PRBC strategy?
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SBAhardTransfusionBlood ProductsVariceal bleeding
A patient with suspected variceal bleeding has Hb (Haemoglobin) 81 g/L and is awake and responsive. Which statement is most accurate regarding PRBC transfusion?
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SBAmediumTransfusionBlood ProductsTrauma
120y
BP
↓↓
Haemoglobin120↓(130-170)

Which statement is most accurate?

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Related Topics

See also: Hypovolaemic Shock, Trauma Primary Survey, Shock: The Complete Guide