University Hospital of Wales Paediatric Intensive Care Unit Guideline Printed on Wed 23-jul-08
Search Site

Last updated March 21, 2013 8:29 AM

Referrals
02920 745413

External links

Fax 02920 746443

logo

University Hospital of Wales Heath Park
Cardiff
CF14 4XW
02920 747747

Blood products

Blood

10 - 15ml/kg
Keep Hb > 10g/dl in acute resuscitation phase - (generally first 24 hours)
Transfusion threshold for stable critical care patients 7g/dL

FFP

15 ml/kg if APTT or PT > 1.5 X normal

Cryoprecipitate

5ml/kg if Fibrinogen < 1.0
FFP contains some fibrinogen, so if received FFP, recheck fibrinogen level before ordering cryoprecipitate

Platelets

10-15ml/kg
Transfusion thresholds (for impaired platelet production)
< 10
< 20 and DIC, or platelets likely to fall by 10 by time of next sample
< 50 and acute bleeding
< 100 and CNS bleeding or multiple trauma

D/W consultant if ITP or previous intrauterine transfusions
Check platelet increment 30mins after transfusion, high consumption eg. sepsis may need repeat transfusions

Coagulation tests


Activated partial thromboplastin time (APTT)


Also known as partial thromboplastin time with kaolin, PTTK, this tests the intrinsic and common pathways.

Interpretation:

Artefactual prolongation of the APTT may be due to the presence of heparin in the sample, difficult or slow collection, addition of an incorrect volume of blood to the tube, delay in mixing blood with the citrate anticoagulant, suboptimal specimen storage or a prolonged interval between collection and testing.

Prothrombin time (PT)


This tests the extrinsic and common pathways.
More sensitive than the APTT for the detection of coagulation factor deficiencies due to vitamin K deficiency, liver disease.
The results are expressed as an international normalised ratio (INR) when the test is used to monitor oral anticoagulant therapy. The INR is not, however, valid for other patients, especially those with liver disease.

Interpretation:

An abnormal result is most often due to


 

Thrombin time

Investigation of possible acquired or inherited disorders of haemostasis; occasionally indicated in the investigation of unexplained thrombosis.

Interpretation

Prolonged by

Reptilase Time
Reptilase is a thrombin-like enzyme that differs from thrombin in its specificity and extent of cleavage of the fibrinogen molecule. Reptilase is inhibited only slightly or not at all by Heparin and fibrin degradation product (FDP), thus making it useful in the differential diagnosis of a prolonged thrombin time (TT).

Interpretation

Prolonged by:

A reptilase time is only needed in the presence of a prolonged thrombin time. In this case, if the reptilase time is normal, the presence of heparin is confirmed.
If it is prolonged, heparin can be excluded and other causes of prolonged thrombin time may be pursued such as: hypofibrinogenemia and dysfibrinogenemia.

Activated clotting time (ACT)
This is performed as a 'bedside' test. It is used to quantify the heparin effect during haemofiltration. The normal range is 100-140 seconds.
Clinical use of the ACT in assessing adequacy of heparinisation

Interpretation

Prolonged by