TRANSFUSION CODES - RED CELL CONCENTRATES

 CODE

 EXPLANATION

INDICATION

R1

Acute Bleeding

• Patients with acute blood loss and haemodynamic instability.
• Decisions about the use of red cell transfusion in acute blood loss situations should be made by
experienced clinicians.
• Hb may be unreliable.
• When normovolaemic use Hb thresholds below

R2

Hb ≤70g/L stable patient
Acute anaemia

• Use an Hb threshold of 70g/L and a target Hb of 70-90g/L to guide red cell transfusion.
• Follow local protocol for indications such as post
cardiac surgery, traumatic brain injury, acute cerebral ischaemia

R3

Hb ≤80g/L if cardiovascular disease

• Use an Hb threshold of 80g/L and a target Hb of 80-100g/L to guide red cell transfusion.

R4

Chronic transfusion dependent
anaemia

• Transfuse to maintain an Hb which prevents symptoms. Suggest an Hb threshold of 80g/L initially and adjust as required.
• Haemoglobinopathy patients require individualised Hb thresholds depending on age and diagnosis.

R5

Radiotherapy maintain Hb
≥100g/L

• There is some evidence for maintaining an Hb of 100g/L in patients receiving radiotherapy for cervical and possibly other tumours.

R6

Exchange Transfusion

• Code only to be used for exchange transfusions.

TRANSFUSION CODES - FFP (15ml/kg)

 CODE

 EXPLANATION

INDICATION

F1

Major Haemorrhage

Early use in trauma – 1 unit FFP: 1 unit red cells. Other settings at least 1 unit FFP: 2 units red cells. Once bleeding controlled, use thresholds below.

F2

PT Ratio/INR >1.5 with bleeding

Without major haemorrhage. Keep PT/APTT ratio of <1.5.

F3

PT Ratio/INR >1.5 and pre-procedure

e.g. Disseminated Intravascular Coagulation (DIC) with risk of significant bleeding.

F4

Liver disease with PT ratio/INR >2 and pre-procedure

 Not usually required if no bleeding or before invasive procedure if PT ratio/INR is <2.

F5

TTP/plasma exchange

F6

Replacement of single coagulation factor

Where factor concentrate unavailable.

TRANSFUSION CODES - PROTHROMBIN COMPLEX CONCENTRATE (i.e. Octaplex®)

PCC1

Emergency reversal of VKA

For severe bleeding or head injury with suspected intracerebral haemorrhage

PCC2

Emergency reversal of VKA for pre-emergency surgery

TRANSFUSION CODES - CRYOPRECIPITATE (2 pooled units for adult) Use with FFP unless isolated fibrinogen deficiency

 CODE

 EXPLANATION

INDICATION

C1

Clinically significant bleeding and fibrinogen <1.5g/L (<2g/L in obstetric bleeding)

C2

Fibrinogen <1g/L and pre-procedure

 With risk of bleeding

C3

Bleeding associated with thrombolytic therapy

C4

Inherited hypofibrinogenaemia

When fibrinogen concentrate not available.

TRANSFUSION CODES - PLATELET CONCENTRATE (1 unit = 1 adult therapeutic dose or ATD)

 CODE

 EXPLANATION

INDICATION

PROPHYLACTIC PLATELET TRANSFUSION

P1

Plt <10 x 10⁹/L, reversible bone marrow failure

Not indicated in chronic bone marrow failure if not on intensive treatment, and not bleeding

P2

Plt 10-20 x 10⁹/L, sepsis/haemostatic abnormality

PRIOR TO INVASIVE PROCEDURE OR SURGERY - to prevent bleeding associated with invasive procedures

P3a

Plt <20 x 10⁹/L, central venous line

P3b

Plt <40 x 10⁹/L, pre lumbar puncture/spinal anaesthaesia

P3c

Plt <50 x 10⁹/L, pre liver biopsy/major surgery

P3d

Plt <80 x 10⁹/L, epidural anaesthaesia

P3e

Plt <100 x 10⁹/L, pre critical site surgery

e.g. CNS / eye. Transfusion prior to bone marrow biopsy not required.

THERAPEUTIC USE TO TREAT BLEEDING (WHO BLEEDING GRADE ≥2)

P4a

Major haemorrhage, Plt <50 x 10⁹/L

P4b

Empirically in a Major Haemorrhage Pack / Protocol

P4c

Critical site bleeding, Plt <100 x 10⁹/L

e.g. CNS.

P4d

Clinically significant bleeding, Plt <30 x 10⁹/L

SPECIFIC CLINICAL CONDITIONS

P5a

DIC pre procedure or if bleeding

P5b

Primary immune thrombocytopaenia (emergency pre-procedure/severe bleeding)

PLATELET DYSFUNCTION

P6a

Consider if critical bleeding on anti-platelet agent

P6b

Inherited platelet disorders directed by haemostasis specialist