Blood Products

Provider Level

RN/Paramedic

Class

Hemotherapy / Volume Expander

Mechanism of Action

Replaces lost intravascular volume, restores oxygen-carrying capacity via erythrocytes, and replenishes coagulation factors to treat hemorrhage and coagulopathy.

Indications

Severe hemorrhagic shock, massive traumatic hemorrhage, profound symptomatic anemia, and life-threatening coagulopathy.

Contraindications

Documented patient refusal for religious or personal reasons. Avoid in non-hemorrhagic shock or when risks of volume overload outweigh benefits without specific component needs.

Routes

IV, IO

Onset / Duration

Onset: Immediate restoration of volume and oxygen-carrying capacity. Duration: Intravascular volume expansion lasts hours; surviving red blood cells have a lifespan of several weeks.

Adverse Effects

Acute hemolytic transfusion reactions, febrile non-hemolytic reactions, allergic reactions, Transfusion-Related Acute Lung Injury (TRALI), Transfusion-Associated Circulatory Overload (TACO), hypothermia, hypocalcemia secondary to citrate toxicity, and hyperkalemia.

Precautions & Interactions

Must only be administered with Normal Saline. Do not mix with Lactated Ringer's (calcium can cause clotting in the line) or Dextrose solutions (causes hemolysis). Monitor vital signs and respiratory status continuously for signs of transfusion reactions.

Special Considerations

Requires strict verification of patient identity and blood type compatibility if cross-matched, though emergency prehospital use typically utilizes universal donor whole blood or packed red blood cells (O-negative, or O-positive for males and post-menopausal females). Use an approved blood warmer if possible to prevent hypothermia. Anticipate the need for calcium administration during massive transfusions to counteract citrate toxicity.