Guidelines for Blood Transfusion in Patients

  • Fernando MartinezEmail author
Reference work entry


Red blood cells (RBC) are transfused to improve oxygen-carrying capacity in patients in which the physiologic mechanisms of response and compensation are decreased and are unable to achieve adequate oxygenation of tissues. Platelets are transfused in most patients as a prophylactic measure to prevent intracranial bleed or when the patient is bleeding and is receiving antiplatelet medication or the platelets are dysfunctional. Plasma is transfused to correct deficiency of coagulation factors or for patients that are receiving anticoagulation medications. Guidelines for the use of blood component should be used as part of the whole management of the patient, and the clinical picture and symptoms of the patient need to be considered before ordering blood components.


Bleeding Transfusion Bloodless medicine Guidelines for transfusion 


  1. 1.
    Abdel-Wahab OI, Healy B, Dzik WH. Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities. Transfusion. 2006;46:1279–85.CrossRefGoogle Scholar
  2. 2.
    Alsaleh K, Alotaibi GS, Almodaimegh HS, Aleem AA, Kouroukis CT. The use of preoperative erythropoiesis-stimulating agents (ESAs) in patients who underwent knee or hip arthroplasty: a meta-analysis of randomized clinical trials. J Arthroplast. 2013;28:1463–72.CrossRefGoogle Scholar
  3. 3.
    Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, Noveck H, Strom BL. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348:1055–60.CrossRefGoogle Scholar
  4. 4.
    Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, Gernsheimer T, Holcomb JB, Kaplan LJ, Katz LM, Peterson N, Ramsey G, Rao SV, Roback JD, Shander A, Tobian AA. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA. 2016;316:2025–35.CrossRefGoogle Scholar
  5. 5.
    Carson JL, Terrin ML, Barton FB, Aaron R, Greenburg AG, Heck DA, Magaziner J, Merlino FE, Bunce G, McClelland B, Duff A, Noveck H. A pilot randomized trial comparing symptomatic vs. hemoglobin-level-driven red blood cell transfusions following hip fracture. Transfusion. 1998;38:522–9.CrossRefGoogle Scholar
  6. 6.
    Gaydos LA, Freireich EJ, Mantel N. The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med. 1962;266:905–9.CrossRefGoogle Scholar
  7. 7.
    Georgiev GP, Tanchev PP, Zheleva Z, Kinov P. Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: review of literature. J Orthop Translat. 2018;13:7–12.CrossRefGoogle Scholar
  8. 8.
    Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409–17.CrossRefGoogle Scholar
  9. 9.
    Heddle NM, Cook RJ, Arnold DM, Liu Y, Barty R, Crowther MA, Devereaux PJ, Hirsh J, Warkentin TE, Webert KE, Roxby D, Sobieraj-Teague M, Kurz A, Sessler DI, Figueroa P, Ellis M, Eikelboom JW. Effect of short-term vs. long-term blood storage on mortality after transfusion. N Engl J Med. 2016;375:1937–45.CrossRefGoogle Scholar
  10. 10.
    Holland L, Sarode R. Should plasma be transfused prophylactically before invasive procedures? Curr Opin Hematol. 2006;13:447–51.CrossRefGoogle Scholar
  11. 11.
    Karam O, Tucci M, Combescure C, Lacroix J, Rimensberger PC. Plasma transfusion strategies for critically ill patients. Cochrane Database Syst Rev. 2013;12:CD010654.Google Scholar
  12. 12.
    Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O'Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, Webert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, Tobian AA, AABB. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015;162:205–13.CrossRefGoogle Scholar
  13. 13.
    Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013;347:f4822.CrossRefGoogle Scholar
  14. 14.
    Munoz Gomez M, Bisbe Vives E, Basora Macaya M, Garcia Erce JA, Gomez Luque A, Leal-Noval SR, Colomina MJ, Comin Colet J, Contreras Barbeta E, Cuenca Espierrez J, Garcia De Lorenzo YMA, Gomollon Garcia F, Izuel Rami M, Moral Garcia MV, Montoro Ronsano JB, Paramo Fernandez JA, Pereira Saavedra A, Quintana Diaz M, Remacha Sevilla A, Salinas Argente R, Sanchez Perez C, Tirado Angles G, Torrabadella De Reinoso P. Forum for debate: safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient. Med Int. 2015;39:552–62.Google Scholar
  15. 15.
    Pfuntner A, Wier LM, Stocks C. Most frequent procedures performed in U.S. hospitals, 2011. HCUP Statistical Brief #165 [Online]. Agency for Healthcare Research and Quality, Rockville; 2013. Available: Accessed 20 Apr 2018.
  16. 16.
    Price TH, Boeckh M, Harrison RW, McCullough J, Ness PM, Strauss RG, Nichols WG, Hamza TH, Cushing MM, King KE, Young JA, Williams E, McFarland J, Holter Chakrabarty J, Sloan SR, Friedman D, Parekh S, Sachais BS, Kiss JE, Assmann SF. Efficacy of transfusion with granulocytes from G-CSF/dexamethasone-treated donors in neutropenic patients with infection. Blood. 2015;126:2153–61.CrossRefGoogle Scholar
  17. 17.
    Resar LM, Frank SM. Bloodless medicine: what to do when you can’t transfuse. Hematol Am Soc Hematol Educ Program. 2014;2014:553–8.CrossRefGoogle Scholar
  18. 18.
    Roback JD, Caldwell S, Carson J, Davenport R, Drew MJ, Eder A, Fung M, Hamilton M, Hess JR, Luban N, Perkins JG, Sachais BS, Shander A, Silverman T, Snyder E, Tormey C, Waters J, Djulbegovic B, American Association for the Study of, L, American Academy of, P, United States, A, American Society of, A, American Society of, H. Evidence-based practice guidelines for plasma transfusion. Transfusion. 2010;50:1227–39.CrossRefGoogle Scholar
  19. 19.
    Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, Mccullough JJ, Omel JL, Rainey JM, Rebulla P, Rowley SD, Troner MB, Anderson KC. Platelet transfusion for patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2018;36:283–99.CrossRefGoogle Scholar
  20. 20.
    Steiner ME, Ness PM, Assmann SF, Triulzi DJ, Sloan SR, Delaney M, Granger S, Bennett-Guerrero E, Blajchman MA, Scavo V, Carson JL, Levy JH, Whitman G, D'Andrea P, Pulkrabek S, Ortel TL, Bornikova L, Raife T, Puca KE, Kaufman RM, Nuttall GA, Young PP, Youssef S, Engelman R, Greilich PE, Miles R, Josephson CD, Bracey A, Cooke R, McCullough J, Hunsaker R, Uhl L, McFarland JG, Park Y, Cushing MM, Klodell CT, Karanam R, Roberts PR, Dyke C, Hod EA, Stowell CP. Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med. 2015;372:1419–29.CrossRefGoogle Scholar
  21. 21.
    Van Bodegom-Vos L, Voorn VM, So-Osman C, Vliet Vlieland TP, Dahan A, Koopman-Van Gemert AW, Vehmeijer SB, Nelissen RG, Van De Marang Mheen PJ. Cell salvage in hip and knee arthroplasty: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2015;97:1012–21.CrossRefGoogle Scholar
  22. 22.
    Wandt H, Frank M, Ehninger G, Schneider C, Brack N, Daoud A, Fackler-Schwalbe I, Fischer J, Gackle R, Geer T, Harms P, Loffler B, Ohl S, Otremba B, Raab M, Schonrock-Nabulsi P, Strobel G, Winter R, Link H. Safety and cost effectiveness of a 10 x 10(9)/L trigger for prophylactic platelet transfusions compared with the traditional 20 x 10(9)/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemia. Blood. 1998;91:3601–6.PubMedGoogle Scholar
  23. 23.
    Weltert L, Rondinelli B, Bello R, Falco M, Bellisario A, Maselli D, Turani F, De Paulis R, Pierelli L. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial. Transfusion. 2015;55:1644–54.CrossRefGoogle Scholar
  24. 24.
    Yang C, Wang J, Zheng Z, Zhang Z, Liu H, Wang H, Li Z. Experience of intraoperative cell salvage in surgical correction of spinal deformity: a retrospective review of 124 patients. Med (Baltimore). 2016;95:e3339.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Laboratory MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations