The Impact of Blood Utilization Guidelines on Product Usage

• Regardless of the patient’s hemoglobin value in a patient with normovolemia and symptomatic anemia

• Patient with acute blood loss of >15% of estimated blood volume

• Patient with acute blood loss with evidence of adequate oxygen delivery

• Preoperative hemoglobin 8 g/dL and operative procedure associated with major blood loss

• Hemoglobin <8 g/dL in a patient on a long-term transfusion regimen

• Hematocrit ≤21% or hemoglobin ≤7 g/dL in a patient with no known cardio-respiratory disease

• Hematocrit ≤25% or hemoglobin ≤8 g/dL in a patient with cardiac, cerebral, or other major organ ischemia or hypoproliferative anemia

• Rapid blood loss with >20% not responding to appropriate volume resuscitation, or with ongoing blood loss

• Platelet count ≤10 000/µL prophylactically in a patient with failure of platelet production

• Platelet count ≤20 000/µL and signs of hemorrhagic diathesis (petechiae, mucosal bleeding)

• Platelet count ≤50 000/µL in a bleeding patient or a patient undergoing an invasive procedure

• Active hemorrhage

• Platelet dysfunction as documented by platelet function test result(s) or medication known to cause platelet dysfunction

• Active bleeding or a patient undergoing an invasive procedure with an INR >1.6 or APTT >40s

• Plasma exchange for TTP or HUS

• Emergency reversal of warfarin

• Fibrinogen ≤100 mg/dL

• Renal failure with an abnormal closure time (platelet function test) and one of the following: active hemorrhage, operation, or invasive procedure within 24 h

• Von Willebrand disease if DDAVP or Humate-P (or comparable factor concentrate) is not available