Transfusion recommendations:
Blood and blood products can be administered in the Emergency Department (ED) under the following outlined circumstances. A written physician order must be obtained except in cases of severe hypovolemic shock where a verbal order can be taken until the physician can write the order.
Traumatically injured patients who require blood products for stabilization.
Medically unstable patients who require immediate transfusion of blood products for stabilization.
Patients who need a transfer to another facility but require a transfusion prior to acceptance.
Patients with Iron Deficiency Anemia, hemoglobin <3 g/dL, and are stable for which an inpatient bed will not be available two hours after transfusion order was placed. (See Iron Deficiency Anemia – Disposition and Management)
Patients with Iron Deficiency Anemia and are hemodynamic unstable, with severe symptoms (e.g., AMS/seizures, respiratory distress, hypoxia) and/or hemoglobin ≤3g/dL regardless of symptoms should be admitted to the PICU for urgent transfusion and hemodynamic support.
If a PICU bed will not be available within one hour of transfusion order, the ED will begin transfusing with consultation and guidance from the PICU and Hematology teams.
Patients with a hemoglobin ≤ 5 g/dL who are stable and it has been deemed necessary for them to receive a blood transfusion but will not be transferred to the floor within four hours of the transfusion order.
Any patient not mentioned above that the ED team and Hematology team have agreed that a transfusion is necessary and will not have a ready bed within four hours of transfusion order.
Keywords: anemia, blood, iron, transfusion