Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul-Sep;43(3):280-286.
doi: 10.1016/j.htct.2020.05.010. Epub 2020 Jul 23.

Transfusion practices in cirrhotic patients at a tertiary liver care center from Northern India

Brinda Kakkar  1 , Rakhi Maiwall  1 , Meenu Bajpai  2
Affiliations

Transfusion practices in cirrhotic patients at a tertiary liver care center from Northern India

Brinda Kakkar et al. Hematol Transfus Cell Ther. 2021 Jul-Sep.

Abstract

Introduction: Transfusion in cirrhotic patients remains a challenge due to the absence of evidence-based guidelines. Our study aimed to determine the indication of transfusion and the associated transfusion thresholds in cirrhotic patients.

Methods: This retrospective observational study was conducted in the Department of Transfusion Medicine at a tertiary care liver center from October 2018 to March 2019. The blood bank and patient records of cirrhotic patients admitted during the study period were retrieved and analyzed to determine the current transfusion practice.

Results: A total of 992 cirrhotic patients were included in the study. Blood components were transfused to 402 (40.5%) patients. Sixty-nine (17.2%) patients were transfused to control/treat active bleeding, while 333 (82.8%) were transfused prophylactically. Packed red blood cells (65.4%) was the most commonly transfused blood component, followed by fresh frozen plasma (35.6%), among patients receiving transfusions (therapeutic & prophylactic). The mean pre-transfusion thresholds for: (i) packed red blood cell transfusion: hemoglobin less than 7g/dL; (ii) fresh frozen plasma transfusion: international normalized ratio over 2.6; (iii) platelet concentrate transfusion: platelet count less than 40,700/μL, and; (iv) cryoprecipitate transfusion: fibrinogen less than 110mg/dL. The average length of stay of the study population was 5 days (3-9).

Conclusion: To conclude, 40.5% of our hospitalized cirrhotic patients were transfused, with the majority of the transfusions being prophylactic (82.8%). Separate guidelines are required for this patient population, as these patients have an altered hemostasis which responds differently to the transfusion of blood components.

Keywords: Blood transfusion; Cirrhosis; Coagulopathy; Thresholds; Transfusion practice.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart summarizing the frequency of transfusions in cirrhotic patients. TPE: therapeutic plasma exchange; ICU: intensive care unit; PRBC: packed red blood cell; FFP; fresh frozen plasma; PC: platelet concentrate; CP: cryoprecipitate.
See this image and copyright information in PMC

References

    1. Yates S.G., Gavva C., Agrawal D., Sarode R. How do we transfuse blood components in cirrhotic patients undergoing gastrointestinal procedures? Transfusion. 2016;56(4):791–798. - PubMed
    1. Fatourou E.M., Tsochatzis E.A. Transfusion strategies in patients with cirrhosis: less is more. Liver Int. 2016;36(4):503–504. - PubMed
    1. Tripodi A., Mannucci P.M. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147–156. - PubMed
    1. Tripodi A., Primignani M., Chantarangkul V., Viscardi Y., Dell’Era A., Fabris F.M. The coagulopathy of cirrhosis assessed by thromboelastometry and its correlation with conventional coagulation parameters. Thromb Res. 2009;124(1):132–136. - PubMed
    1. Blonski W., Siropaides T., Reddy R.K. Coagulopathy in liver disease. Curr Treat Options Gastroenterol. 2007;10(6):464–473. - PubMed