Blood Conservation Strategies During COVID-19

The COVID-19 pandemic is putting pressure on the national blood supply. Our blood supplier – the American Red Cross – has asked us to implement measures to reduce blood utilization by 25%. The strategies are not a significant change from current practice but are meant as reminders to help us all conserve VUMC’s blood supply.  Bolded strategies will be especially helpful.

General Blood Conservation Strategies:

  • Only order blood that will be transfused (not to the bedside just in case)
  • Please obtain a Type & Screen on trauma patients ASAP so we can switch from using O red blood cells when possible
  • Do not put platelets into Trauma/Massive Transfusion/OR coolers
  • Do not order single units to be put into coolers (order via tube since that unit will be transfused right away to the patient)
  • The Blood Bank staff and physicians will be questioning excessive/abnormal orders

When to transfuse Packed Red Blood Cells (pRBCs):

  • In general, for stable adults and children, only consider transfusion of pRBCs when the Hgb is 7 g/dL, or 8 g/dL for an adult with cardiovascular disease
  • Consider need for elective surgeries to proceed given their potential for transfusion

When to transfuse Platelets:

  • For prophylactic platelet transfusions in non-bleeding patients with hematologic/oncologic diagnoses, transfuse 1 unit (or 10mL/kg to children) of apheresis platelets
  • For patients undergoing surgery/procedures, transfuse 1 unit of apheresis platelets (or 10 mL/kg to children) to ensure platelet count is > 50, 000
  • For patients undergoing neurosurgery or ophthalmologic surgery, transfuse 1 unit of apheresis platelets (or 10 mL/kg to children) to ensure platelet count is > 100,000
  • All orders for > 1 apheresis unit will not be honored
  • No HLA platelet orders will be honored at this time
  • For neonates, strongly consider only transfusing 10 mL/kg of platelets when platelet count is < 25, 000, even when bleeding

When to transfuse Fresh Frozen Plasma (FFP):

  • In bleeding patients or those with disseminated intravascular coagulopathy (DIC) who need global factor replacement (i.e. not specific factor deficiencies)
  • Those patients who have a significant coagulopathy (INR > 2.0) who are expected to have bleeding during a procedure/surgery

When to transfuse Cryoprecipitate:

  • In bleeding patients or those with disseminated intravascular coagulopathy (DIC) who need fibrinogen (< 150 mg/dL)
  • Please measure a fibrinogen prior to ordering if possible
  • If the need arises, may need to use human fibrinogen concentrate (only currently on formulary for OB patients at VUMC)

For trauma/Massive Transfusion Protocol (MTP) patients, transfuse per usual practice

Optimizing Ordering Blood and Blood Products