Blood: do you administer platelets or PRBC first?

umcRN, BSN, RN · Apr 18, 2011

Would depend on the pt situation, what's their crit? Are they actively bleeding? If they were just a little low in both and needed a transfusion I would give platelets first because it goes in faster and I work in NICU and our access is often limited.

TravelTrauma · Apr 18, 2011

I agree...I would give the platelets

justus501 · Apr 18, 2011

Hmmm...interesting question. I have worked ICU and we used to give them simultaneously, as we had multiple IV's or a Triple Lumen Catheter. If you didn't have multiple access, It would depend on the situation. My initial thought is that the blood should be given first, as it has oxygen carrying capacity, and platelets do not. Do not be afraid to ask the physician which he would like given first.

MunoRN, RN · Apr 18, 2011

If they have active bleeding it would make sense to give platelets or any other product intended to help control the bleeding first such as FFP or clotting factors, otherwise the PRBC's will just end up bleeding back out. In reality, give both, or if I've got PRBC's in my hand and I'm waiting on platelets with a patient who's Hct is 17 with an active bleed then I'll run the the PRBC's.

It's sort of like if you have a leak in your boat, it makes more sense to fix the leak before you start bailing water, unless you are on the verge of sinking.

caroladybelle, BSN, RN · Apr 18, 2011

It depends on what the dept/main issue is.

I work Hematology (acute leukemia) and as a general rule platelets first. The reasoning : our usual thereshold is for 10k to 20k, depending temp/bleeding issues. If they drop below, spontaneous bleeds/head bleeds become an issue, so we give platelets stat. Threshold for Hct is 25-30%, barring acute leukostasis, so transfusion of reds is not a major hurry. But this can change based on situation. When we give cryo for low fibrinogen, it is almost always a DIC issue thus that takes priority.

But also, invariably, cryo takes only a brief time to infuse and platelets can often be run quite quickly, more so than prbcs. They also will help stop bleed if that is why you need reds.

LegzRN · Apr 18, 2011

I give the platelets first for the sheer fact that I can fly them in. On a trauma pt, we have protocols, though.

emt123277 · Apr 18, 2011

Blood transfusion takes time. Platelets and FFP get pounded in. IMO it would be RBCs last unless the pts hgb is so low they're not perfusing... in that case you'd have multiple lines and be squeezing major fluids via a Level 1 Infuser or pressure bags.

TJacob · Apr 18, 2011

Thank you very much everyone! I appreciate the rationale behind the reasoning :)

Though I believe I have the answer, the details were that shes a pediatric pt with meduloblastoma.

Wbc: 2,000/mm₃

Hgb: 7.2 g/dl

Hct: 19.3 %

Plt: 18,000

She has a single lumen infusa-port.

Thank you!

FENT · Apr 18, 2011

Ive looked everywhere and cant find the answer. Does anyone know which blood product you would transfuse first, platelets or pRBC? Thank you :)

I know we need consent before we give blood what else must we have?

caroladybelle, BSN, RN · Apr 18, 2011

One would still need more data to make proper decision. Many onco departments would require a higher platelet goal, at least 20 to 50k for anyone with a brain lesion d/t heightened risk of brain bleeds.

However, if the pt is having serious issues with anemia (having an MI, infarcting d/t inadequate oxygenation) , that may take precedence . However, if the issue were that serious, you would starting several other lines. But that scenario would be more common in older pts with lower Hct.

The vital signs, the other labs, the EKG, pulse ox/ O2 need, the pts symptomology would determine that.

FENT · Apr 18, 2011

Last week a pt with thrombocypenia required two platelet transfusions, next week scheduled for a third.