Initial RBC transfusion practices

If a patient requires red blood cell transfusion, do you start from one unit and then decide about the next one, or do you administer 2 units up front?

Mark Crowther: This is an interesting question that has recently also been subject to a lot of interest. There are 2 schools of thought. For patients receiving elective or semielective transfusions who are, for example, outpatients, we generally give one unit nowadays, reassess them afterwards, and see whether they require additional transfusion.

That is counterbalanced by the idea of massive transfusion protocols, where in patients who have acute bleeding with very low hemoglobin levels we are actually moving towards much more rapid initial therapy with 4 to 6 units of packed cells in order to try to get ahead of the bleeding complications.

It is not a simple question to answer. For elective therapy one unit with reassessment is probably best practice. In a patient who requires large-volume transfusions due to active bleeding or trauma, we should probably start with >2 units as the initial transfusion.