Blood Components for Hemostasis

Abstract

We present an overview of revised indications and doses for routinely transfused blood components. Targeted blood component therapy is one of the earliest models of personalized medicine, striving to achieve the tenets of the right dose at the right time for the right reason to the right patient. Despite rigorous quality assessment and federally mandated regulatory requirements, blood component therapy has fallen short of this goal. Transfusion support practices largely are dictated by expert opinion and tradition with few evidence-based recommendations. Blood component transfusions, while mostly regarded as safe, are not without risk for serious adverse outcomes. Pharmaceutical agents commonly used either in lieu of, or in addition to, transfusion support will also be discussed. * Abbreviation Key : RBCs : red blood cells HIV : human immunodeficiency virus TRALI : transfusion-related acute lung injury HTRs : hemolytic transfusion reactions HLA : human leukocyte antigen CMV : cytomegalovirus VWF : von Willebrand factor ADP : adenosine diphosphate TAS : transfusion-associated sepsis NSAID : nonsteroidal anti-inflammatory drug DDAVP : desmopressin acetate TTP : thrombotic thrombocytopenic purpura HELLP, hemolysis, elevated liver enzymes : and low platelet count HUS : hemolytic uremic syndrome HIT : heparin-induced thrombocytopenia ITP : immune thrombocytopenia PTP : post-transfusion purpura WHO : World Health Organization CCI : corrected count increment DIC : disseminated intravascular coagulation FFP : fresh frozen plasma TPE : therapeutic plasma exchange VKA : vitamin K antagonism PT : prothrombin time INR : international normalized ratio TACO : transfusion-associated circulatory overload FDA : US Food and Drug Administration PCC : prothrombin complex concentrate EACA : e-aminocaproic acid TXA : tranexamic acid rFVIIa : recombinant Factor VIIa