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Blood transfusion

Ward jobs

Restrictive threshold: transfuse below Hb 70 g/L, target 70–90. Acute coronary syndrome: below 80, target 80–100.

Give one unit, then reassess the patient and the Hb.

Act now

  1. 1

    Explain risks, benefits and alternatives, and document consent.

  2. 2

    Positive patient identification at every step; group and save per local two-sample rule.

Assess

  • Why is the Hb low? Bleeding, haemolysis, iron, B12 or folate deficiency — treat the cause.
  • Symptoms, cardiac disease, valid consent, previous reactions, special requirements (irradiated, CMV-negative).
  • TACO risk: older age, heart failure, renal impairment, low albumin, low body weight, positive fluid balance.

Investigations

  • Haematinics before transfusing; FBC after each unit.

Manage

  • Iron deficiency without haemodynamic compromise: oral or IV iron instead of transfusion.
  • One unit usually raises Hb by about 10 g/L in a 70 kg adult — dose by weight in low-weight patients.
  • Platelets: prophylactic if under 10 × 10⁹/L; under 50 before most procedures; under 30 with clinically significant bleeding.
  • Suspected reaction: stop the transfusion, ABCDE, check the patient against the unit, treat anaphylaxis if present, inform the lab and report (SHOT/SABRE).

Escalate when

  • Major haemorrhage, suspected acute reaction, wrong blood, TACO or TRALI: senior and haematology now.

Doses and prescribing

Red cells

1 unit IV, usually over 90–120 minutes (complete within 4 hours of leaving the fridge).

Furosemide

20–40 mg with the transfusion if at risk of TACO, per local policy.

Check the BNF and your local formulary before prescribing.

Written to current guidance (NICE NG24) · sources checked 14 Nov 2026. We watch NICE for updates weekly.

Sources (2)

Reviewed by Aboodee Alhasso, MPharm MRCPharm IP on 14 Nov 2026

For healthcare professionals, as an aid to clinical judgement — not a substitute for it. Follow your local policy and ask a senior when in doubt.