Hb < 7
Hb < 7 transfusion order:
- Transfusion consent
- Fill out the (usually pink) transfusion form
- Write down transfusion order in kardex
- Transfusion order:
- Transfuse 1 unit packed cell Q4H per unit
- (Some wards require you to spell out packed cell, cannot abbreviate with p.c)
- Post-lasix
- Remark in IPMOE w/h if sbp < 120
- Feel free to not write down “1 dose” for the as-directed post-lasix if you anticipate more than one packed cell transfusion
- Post-CBC RFT
If Hb < 7 and hyperkalemia, then lower the K and immediately recheck RFT for a normal K before transfusion.
- If very urgent situation, such as hemodynamically unstable / rather low Hb, you may consider cardiac monitor for any hyperkalemia changes. Then DI drip on one IV access, transfuse concurrently on the other IV access.
- This I was told by a cardiac MO that he would do that theoretically. I have not seen it done in practice. I am not sure if there is really hyperkalemia changes, what would the next step be after injecting calcium gluconate. If you stopped the transfusion, there is a chance you might have to AIRS because the transfusion wasn’t completed.
Rapid Hb drop but Hb > 7
If active hemorrhage / bleeding, then would likely still need to transfuse, omitting the post-lasix.
Some medical MOs like to transfuse to keep Hb > 8 in pt with cardiovascular problems.
Template for incidental Anemia
Anemic workup:
- Iron profile (iron, ferritin, transferrin)
- B12/folate
- Reticulocyte
- ± LDH, haptoglobin
PE
- GC well alert
- no jaundice
- No bleeding signs
- No PRB/tarry stool/haematuria
- Abd SNT
- PR: no blood
Check Hx of OGD / CLN and findings.
May consult surgery: offered OGD in view of ↓Hb, I/R/B told including risk of bowel perforation
If refusal: patient refused OGD. Explained risk of missing pathologies including risk of UGIB/malignancy. Informed patient to AED if bleed Sx/tarry stool, anaemic Sx and red flags told and understood