TABLE 93.2 BLOOD PRODUCTS AND DRUGS TO MANAGE BLEEDING Product/drug Indication(s) Dose Pearls Packed red blood Anemia cells (pRBCs) Volume of packed • Desired Hb level RBCs = ([desired dictated by hemoglobin − clinical situation current hemoglobin] • 10 mL/kg of × patient’s blood pRBCs should volume)/hemoglobin raise the Hb of packed RBCs about g/dL Estimated blood (often used volume (mL) = empirically in weight (kg) × 70 acute blood loss) mL/kg • Rate of transfusion Estimated hemoglobin is dictated by of unit of packed clinical RBCs = 19–25 g/dL presentation and differs for acute versus chronic etiologies of anemia Platelets One unit per 5–10 kg (∼50–60 mL/unit), ≥5.5 × 1010 platelets/unit OR One apheresis unit (∼200 mL), ≥3 × 1011 platelets/unit Thrombocytopenia with bleeding Platelet function defects • Use with caution/clear clinical need for patients with ITP, DIC, TTP, HIT • Random donor units are a pooled donor source An apheresis unit is from a single donor • One unit of random donor platelets should increase count by 5,000–10,000/μL in average adult • One apheresis unit should increase count by 30,000– 50,000/μL in average adult Fresh-frozen plasma (FFP) Bleeding associated with abnormal coagulation panel Factor deficiency replacement Reversal of vitamin K antagonist Massive transfusion requirement 10–20 mL/kg/dose (∼200–250 mL/unit) Cryoprecipitate (Cryo) Bleeding associated 1–2 units for every 10 with deficiency of kg of body weight fibrinogen, FVIII, FXIII, or VWF • Contains all plasma-clotting factors, but with variable concentrations • Contains fibrinogen, FVIII, FXIII, and VWF Recombinant Factor VIII products: factor products treatment or prophylaxis of FVIII deficiency Factor IX products: treatment or prophylaxis of FIX deficiency Factor VII (rFVIIa): treatment or prophylaxis of FVII deficiency or treatment or prophylaxis for FVIII or FIX patients with inhibitors Factor VIII: (number • Plasma-derived of units = desired factor level [%] × weight replacement of patient [kg] × 0.5) products also available Factor IX: (number of units = desired level [%] × weight of patient [kg]) Factor VII: Replacement: 15–30 mcg/kg q4–q6hr FVIII or FIX inhibitors: 90 mcg/kg q2hr, space as clinically tolerated Antihemophilic factor/VWF complex von Willebrand disease (VWD) Dosing based on VWF:RCo units/kg Prothrombin complex concentrates Bleeding with Consult hematologist, deficiency of FII, dose for factor FVII, FIX, FX, or replacement based familial vitamin K on specific factor deficiency or • Contraindicated in DIC, HIT, or known hypersensitivity reversal of vitamin K antagonist deficiency and target level Dose for reversal depends on specific product and predose INR DDAVP Type I VWD or mild IV formulation—0.3 • Causes release of (desmopressin) hemophilia A (if mcg/kg in 50-mL VWF and FVIII patients known to NS by IV infusion from endothelial respond) over 30 (max cells dose 20 mcg) • Can exacerbate the Nasal spray thrombocytopenia formulation Stimate seen with type 2B (desmopressin VWD acetate) 1.5 mg/mL • Side effects: facial —metered dose flushing, pump delivers 0.1 headache, and, mL (150 mcg) per rarely, actuation for hypertension, patients ≥50 kg—2 hypotension, and sprays (1/nostril); water retention,