Clinico-Therapeutic Cases

Anemia and Transfusion and

Drugs for Bleeding Disorders

Transers: RXmen
 OUTLINE
I. Anemia
A. Definition
B. Etiology
C. Clinical Presentation
D. Diagnostic Testing
E. Anemias associated with decreased RBC
production
1. Microcytic Anemia
2. Thalassemia
3. Sideroblastic Anemia
4. Macrocytic/Megaloblastic Anemia
5. Anemia of chronic renal insufficiency
6. Aplastic Anemia
F. Anemia associated with increased RBC
destruction
1. Sickle Cell Disease
2. G6PD Deficiency
3. Autoimmune hemolytic anemia
4. Drug-Induced Hemolytic Anemia
5. Microangiopathic Hemolytic Anemia
II. Transfusion Medicine
A. Packed RBC
B. Fresh Frozen Plasma
C. Platelet
D. Cryoprecipitate
 OUTLINE
III. Drugs for bleeding disorders
A. Vitamin K
B. Fibrinolytic Inhibitors
C.Serine Protease Inhibitors
IV. Formula
 ANEMIA

Transers: RXmen
 DEFINITION

Anemia is defined as decrease in

circulating RBC

Women Men

Hemoglobin <12 g/dL <14 g/dL

(Hgb)
Hematocrit <36% <41%
(Hct)
 B. ETIOLOGY
Blood loss
Acute
Chronic
Decreased RBC production
Increased RBC destruction
(hemolysis)
C. Clinical Presentation-
History
Acute anemia
Fatigue, malaise, dizziness,
syncope, or angina with
relatively mild anemia (ie. Hct
>30%)
Acute blood loss most
commonly occurs in the
gastrointestinal tract
Chronic anemia
Have less symptoms
Patients usually develop
symptoms when Hb <7 g/dL
C. Clinical Presentation-
Physical Examination
Common signs and symptoms
Pallor, tachycardia,
hypotension, dizziness, tinnitus,
headaches, loss of
concentration, fatigue, and
weakness
In severe anemia
Atrophic glossitis, angular
cheilosis, koilonychias (spoon
nails), and brittle nails
Patients can also experience
reduced exercise intolerance,
dyspnea on exertion and heart
failure
 D. Diagnostic Testing -
Laboratories
CBC
Measures WBC, Hb, Hct, platelets and RBC indices
(MCV, RDW, MCH)
Hb level
Concentration of Hb in blood (g/dL)
Hct
% the RBC occupies the blood
Mean cellular volume (MCV)
Mean volume of red cells
Microcytic: MCV <80 fL (femtoliters)
Normocytic: MCV between 80-100 fL
Macrocytic: MCV >100fL
Red cell distribution width (RDW)
Reflection of variability in the size of red cells
Elevated RDW = increase in variability of RBC size
Mean cellular Hb (MCH)
Concentration of Hb in each cell
Elevated MCH = indicative of
spherocytes/hemoglobinopathy
Reticulocyte count
Percentage of immature red cells in blood
Reflects bone marrows production of RBC
Normal: 1-2%
E. Anemia associated
with DECREASED RBC
production
1. Microcytic Anemia
General Principles
Iron deficiency (IDA) is the most
common cause of anemia in
ambulatory setting
Menstrual blood loss or pregnancy are
the most common etiologies of IDA in
premenopausal women
Diseases of stomach and proximal
small intestine
Clinical Presentation
Patients may present with fatigue or
malaise
Iron deficiency has also been
increasingly associated with restless
leg syndrome
Diagnostic Testing
Ferritin <10 ng/mL in women; <20
ng/mL in men
 Medication for
Iron deficiency anemia (oral)

Ferrous Sulfate
(Rhea Ferrous Sulfate)
325 mg/tablet
#90 tablets

Take 1 tablet every 8 hours for 90 days.

Sig: Take before meals. Return to physician
after 90 days for follow-up

Refill: 2

Warning: Seek consult if nausea, vomiting, and

abdominal pain occurs.
 Medication for
Iron deficiency anemia (parenteral)

Iron sucrose
(Ferrofer)
20 mg/mL per ampule
#5 ampules

Dilute 0.35 ml inj/kg body weight in 500

Sig: mL of 0.9% NaCl not exceeding 25mL of
Ferrofer. Infuse over at least 3.5 hours
once a week.
Refill: 0
Seek consult if itching, headache,
Warning: nausea, cramps, chest pain or low blood
pressure occurs.
 2. Thalassemia
General Principles
Inherited disorders characterized by reduced
Hb synthesis
Decreased production of b-globin and a
resultant excess of a-globin
Clinical Presentation
Family history of microcytic anemia or
microcytosis is helpful
Splenomegaly may be the only physical
manifestation
Skeletal deformities and hematopoietic
massses in B-thalassemia major
Diagnostic Testing
Microcytic, hypochromic RBCs are seen along
with poikilocytosis and nucleated RBCs
Treatment
Generally require no specific treatment
If severe: RBC transfusion until 9-10 g/dL Hb
Chelation therapy indicated for transfusion-
associated iron overload
 Chelation Therapy
Acute Fe Poisoning

Deferoxamine
(Desferal)
500 mg powd for inj/vial
#10 vials

Administer 15 mg/kg/hr not exceeding

Sig:
80 mg/kg in any 24 hour period.

Refill: 0
Perform ophtha & audiological tests prior
Warning: to & during treatment. Monitor renal
function changes & ped patient's body
wt & longitudinal growth every 3 mth.
3. Sideroblastic Anemia
Definition
Are hereditary or acquired RBC disorders
characterized by abnormal iron
metabolism associated with the presence
of ring sideroblasts in the BM aspirate and
normal cytogenetics
Etiology
Acquired
Primary (myelodisplastic syndrome)
Secondary to drugs (chloramphenicol,
cycloserine, ethanol, isoniazid,
pyrazinamide)
Hereditary
X-linked, autosomal, mitochondrial
Treatment
Remove any possible offending agent
 Medication for
Sideroblastic Anemia

Pyridoxine
(Incremin)
10 ml/tsp syrup
#1 bottle

Sig: Take 10 mL syrup once per day

Refill: 0

Warning: Seek consult if nausea, vomiting, and

constipation, and diarrhea occurs.
4. Macrocytic/Megaloblastic
Anemia
Definition
Term used to describe disorders of
impaired DNA synthesis in hematopoietic
cells
Etiology
Almost all cases are due to folic acid or
vitamin B12 deficiency
Clinical Presentation
Folate deficiency
Sleep deprivation, fatigue, depression,
irritability, forgetfullness
Vitamin B12 deficiency
Neurologic symptoms (peripheral
neuropathy, paresthesias, lethargy,
hypotonia, seizures)
Treatment
Replace deficient factors
Patients who decline or who cannot take
parenteral therapy can be prescribed oral
tablets or syrup at 50mg/d for life
 Medication for
Vitamin B12 (Cyanocobalamin)
Deficiency

Vitamin B12
(Nervite)
100 mg vitamin B1, 20 mg vitamin
B6 and 200 mcg vitamin B12 per
tablet
#10 tablets

Sig: Take 1-2 tablets daily. Should be taken

with food. Swallow whole, do not chew
or crush.

Refill: 0

Warning: Seek consult if rashes appear.

 Medication for
Folic acid deficiency

Folic Acid
(Actimed Folic Acid)
5 mg/tablet
#10 tablets

Sig: Take 1 tablet once a day after meals.

Refill: 0

Warning: Seek consult if rashes appear.

 5. Anemia of Chronic Renal
Insufficiency
Definition
Attributed to decreased
endogenous erythropoietin (EPO)
as the creatinine clearance
declines below 50 mL/min
Diagnosis
Normal MCV
Peripheral Smear: RBCs are often
hypochromic with occasional
presence of burr cells
If patients creatinine is > 1.8
mg/dL, the primary cause of
anemia can be assumed to be
EPO deficiency and/or iron
deficiency
 Medication for
Anemia of chronic renal
insufficiency

Epoetin
(Epovax)
4000 IU/mL inj
#1 pre-filled syringe

Administer 50-100 units/kg IV 3 times a

Sig: week.

Refill: 0

Warning: Stop if Shock, skin reactions, increased

BP, eosinophilia, elevation in liver
function tests, hyperkalemia &
abdominal pain occurs
 6. Aplastic Anemia
General Principles
Acquired abnormality of hematopoietic stem
cells that usually present with pancytopenia
Most cases are idiopathic
Other cases are associated with
drug/chemical exposure or caused by viral
illnesses
Clinical Presentation
Pancytopenia
Symptoms are most commonly due to anemia
Fatigue, malaise, dyspnea
Or due to thrombocytopenia
Mucosal bleeding, bruising
Treatment
Immunosuppressive treatment with
cyclosporine, glucocorticoids, and
antithymocyte globulin should be considered
in patients who do not undergo a stem cell
transplant
Transfusions with RBCs should be kept to a
minimum. Prophylactic platelet transfusions are
generally recommended if the platelet count is
below 10,000/mm3
F. Anemias associated
with INCREASED RBC
production
 1. Sickle Cell Disease
General Principles
Sickle shape transformation of Hb under
conditions of deoxygenation
Hb S results from substitution of valine for
glutamic acid at 6th position of the B-globin
chain
Clinical Presentation
Vaso-occlusive complications
Acute painful episodes, acute chest syndrome,
priaprism, retinopathy, functional aspleia, avascular
necrosis
Hemolytic complications
Cholelithasis, leg ulceration, pulmonary hypertension
Renal medulla infarction
Neurologic complications
Infections
Aplastic crisis
Diagnostic Testing
Reticulocytosis, indirect hyperbilirubinemia,
elevated LDH, and decreased or absent
haptoglobin
Leukocytosis and thrombocytosis are common
Peripheral smear: sickle-shaped RBCs, target
cells, and Howell-Jolly bodies
 1. Sickle Cell Disease
Treatment
Acute painful episodes
Morphone (2m/hr basal rate with boluses of 2-10
mg every 6-10 minutes)
Acute chest syndrome
Aggressive transfusion therapy
Priaprism
Hydration + analgesia
Avascular Necrosis
Local heat, analgesics, avoidance of weight
bearing
Cholelithiasis
Wide spectrum antibiotics + cholecystectomy
(when attack subsides)
Leg Ulcers
Rest, leg elevation, intensive local care. Wet-dry
dressings 3-4 times daily
Acute CVA
Long term transfusion to maintain HbS
concentration <50% for at leasr 5 years
Aplastic crisis
Folic acid (5mg/d)
Iron chelation therapy
 2. G6PD Deficiency
General Principles
Represents the most common disorder of
RBC metabolism
Deficiency of G6PD renders RBCs more
susceptible to oxidative damage through
decreased glutathione reduction leading
to chronic or acute episodic hemolysis in
the presence of oxidative stress
Diagnosis
Peripheral blood smear: presence of bite
cells and Heinz bodies (precipitated Hb
within RBCs)
Treatment
Hemolytic crises tend to be self-limiting;
thus, the mainstay of treatment is
supportive
The underlying cause of oxidative stress
should be addressed (i.e., treatment of
infection, removal of drug).
 3. Autoimmune Hemolytic
Anemia (AIHA)
Definition
Results from autoantibodies targeted to
antigens n the patients own RBCs
resulting to extravascular hemolysis
Etiology
Warm antibody: caused by IgG
Cold antibody: caused by IgM
Diagnosis
Peripheral blood smear: spherocytes,
occasional fragmented RBCs,
polychromasia, and nucleated RBCs
Hallmark: (+) DAT/Direct antiglobulin test
(direct Coombs)
Treatment
Warm AIHA
Glucocorticoids (Prednisone
1mg/kg/d)
Splenectomy for steroid resistance
Idiopathic cold AIHA
Avoidance of cold exposure
RBC transfusions at 37oC
4. Drug-Induced Hemolytic
Anemia
General Principles
Drug-induced hemolytic anemia
Drug-induced autoantibodies
Exposure to the offensive agent and act
similarly in warm AIHA. Laboratory testing
reveals (+) DAT for IgG
Hapten formation
Can occur when a drug (usually an
antimicrobial) coats RBC membranes,
forming a new antigenic determinant. If
antibodies against the drug are present
and the patient receives the drug
(particularly at high doses), a DAT positive
hemolytic anemia may result.
Immune complexes
Occur in most cases of drug-induced
hemolysis. IgM (occasionally IgG)
antibodies may develop against a drug
and form a drugantibody complex that
adheres to the RBCs
Treatment
Discontinuing the offending agent
 5. Microangiopathic
Hemolytic Anemia
Definition
A syndrome of traumatic intravascular
hemolysis
Diagnosis
Peripheral blood smear: fragmented RBCs
(schistocytes)
Treatment
Depends on underlying etiology of
microangiopathy
TRANSFUSION
MEDICINE
 Treatment
Packed red blood cells (pRBCs)
Indicated to increase the oxygen-carrying
capacity of bood in anemic or bleeding
patients
Hb threshold for transfusion in general:
Stable patient, no cardiac risk: 7g/dL
Coronary artery disease or risk of
ischemia: may consider a higher
threshold (7-10 g/dL)
One unit of pRBCs increases Hb level by
approximately 1 g/dL or Hct by 3%
Fresh Frozen Plasma (FFP)
Indications
Prolonged prothrombin time (PT) or
activated partial thromboplastin time
(aPTT) (1.5x normal) in a bleeding
patient
Warfarin overdose
Factor deficiencies for which specific
factor concentrates are unavailable
 Treatment
Platelets
Indicated to prevent or treat bleeding in a
thrombocytopenic patient or patients with
dysfunctional platelets
Platelet count threshold
Nonbleeding, stable inpatients:
10x109/L
Nonbleeding, stable outpatient:
20x109/L
Major invasive procedures/bleeding:
50x109/L
High risk surgery (neurosurgery): higher
threshold
One unit of platelets increase count by:
30-50x109/L
Cryoprecipitate
Enriched with: Fibrinogen, vin Willebrand
factor, Factor VIII, Factor XIII
One unit increases fibrinigen
concentration by 7-8 mg/dL
 A. Packed RBC (pRBC)
General indications:
Almost always indicated when Hb level is less than
6g/dl
Use of PRBC is likely to be inappropriate when
Hgb levels is greater than 10 g/L
Adult indications:
PRBC may be given in patients with hemoglobin
concentration of <10g/dL in such cases when
there is:
Disabling angina pectoris
Myocardial infarction
Congestive heart failure due to severe
anemia
Pediatric indications:
Hemoglobin level of < 8 10 g/dl (hematocrit 0.25
0.30) accompanied by tachypnea,
tachycardia, recurrent apnea, poor feeding and
poor weight
Hemoglobin level of < 130 g/dl in acutely ill
neonates with cardiorespiratory disease
Hemoglobin <80g/dL or hematocrit <25% in a
stable neonate with clinical manifestations of
anemia (tachycardia, tachypnea and poor
feeding)
Neonates and premature infants when there is
shock associated with blood loss or sepsis,
cumulative loss of 10%
 A. Packed RBC (pRBC)
Volume and PRBC preparation
PRBC is available in bags of 150200 ml
A bag contains hemoglobin approximately 20
g/100 ml (not less than 45 g per unit) and
hematocrit at 55%75%
Rate of pRBC transfusion
PRBC should be transfused slowly 10-15 drops/
min for the first 10 minutes
Dose
A dose of one unit of compatible Red Blood
Cells will increase the hemoglobin level in an
average sized adult who is not bleeding or
hemolyzing by approximately 1 g/dL or Hct by
3%. In neonates, a dose of 10-15 mL/kg is
generally given, and AS-1 or AS-3 packed red
cells with a hematocrit of approximately 60%
will increase the hemoglobin by about 3 g/dL.
Response
Infusion of 1 unit of packed RBC increases the
hemoglobin of 1 gm/dl and hematocrit by 3%.
In patients who are not actively bleeding,
repeat hemoglobin determination may be
done 15 minutes after transfusion.
 B. Fresh Frozen Plasma
Indications
Multiple coagulation factor deficiencies
associated with severe bleeding or
disseminated intravascular coagulation with
bleeding
Single coagulation factor deficiencies when no
virus-safe fractionated product is available
Bleeding due to hemorrhagic disease of the
newborn, neonates with coagulopathy who
are bleeding or about to undergo an invasive
procedure
For neonatal exchange transfusion AB or type
specific FFP may be used to reconstitute
maternal blood type specific PRBC
Severe bleeding due to warfarin or patients
taking warfarin who will undergo emergency
surgical procedure
Special situation like open heart surgery with
more than 6 units PRBC transfused
They can also be given for trauma casualties
with 30% or more blood loss and who will be
requiring massive transfusion
 B. Fresh Frozen Plasma
Volume
Volume of the unit is approximately 250 ml
but variation may be expected
may vary from 180 to 300 ml
Transfusion dose and rate
Plasma should be administered in doses
calculated to achieve a minimum of 30%
of plasma factor concentration and is
usually achieved with the administration
of 10-20 ml/kg
 C. Random Donor Platelet
(RDP)
Indications
Ongoing massive bleeding to maintain platelet
count >50 x 109 /L, if with CNS trauma or
bleeding maintain platelet count >100 x 109
Patients with massive blood transfusion and
with platelet count
Episodes of hemorrhage or during times of
active treatment in chronic, stable, severe
thrombocytopenia such as aplastic anemia
and myelodysplasia
When mucosal bleeding persists in patients
with hemolytic disorders
Adult patients receiving therapy for acute
leukemia at a threshold of 10,000 u/L
Patients with solid tumors receiving aggressive
therapy as well as those patients with necrotic
tumors to maintain a threshold of 20,000 u/L
Patients with qualitative platelet dysfunction
with bleeding or will be undergoing surgical
intervention
 C. Random Donor Platelet
(RDP)
Volume
Volume 30-50 ml; platelet count > 200
x109 /unit; pH (at expiry) 6.4-7.4)
Transfusion rate and dose
In neonates it is given at 5-10 ml per kilo
and in children it is given at 1 unit per 10
kg
Response
Generally, expect an adult platelet count
increment of approximately 7-10,000/mm3
for each RDP given
In neonates and infants, a dose of 5-10
ml/kg of platelet (RDP or SDP should result
in a 50- 100,000/mm3 increment
 C. Single Donor Platelet (SDP)
Indications
In general SDP should be recommended to
older children and adult patients as much as
possible, especially those on repeated platelet
transfusions
Volume
Single donor unit in a volume of 250-300 ml of
plasma should contain; 1) at least 55 x 109
platelets, 2) ,1.2 x 109 red cells and 3) <0.12 x
109 leukocytes
Infusion Rate
SDP should be infused over 2-3 hours to a
maximum of 4 hours
Response
Generally, expect an adult platelet count
increment of approximately 30-60,000/mm3 for
each SDP given
To be specific, one unit of platelet
concentrate/10 kg body weight in a 60-70 kg
adult, 4-6 single donor units containing at least
240 x 109 platelet should raise the platelet
count by 20-40 x 109 /L
In neonates and infants, a dose of 5-10 ml/kg
of platelet (RDP or SDP should result in a 50-
100,000/mm3 increment.
 D. Cryoprecipitate
Indications
Fibrinogen deficiency where there is clinical
bleeding, an invasive procedure, trauma
DIC with bleeding
Volume
Volume prepared ranges from 20-40 ml
The cryoprecipitate specifications requires that
75% of the packs contain at least 140 mg of
fibrinogen and 70 IU/ml of FV III
Dosing, Transfusion Rate
A typical dose for the treatment of
hypofibrinogenemia is one cryoprecipitate unit
per 7-10 kg of body weight. It is given as a fast
drip.
Number of precipitate estimated using:
Weight (KG) x 70 ml/kg = blood volume (ml)
Blood volume (ml) x (1.0-hematocrit) = plasma
volume (ml)
Fibrinogen required (mg) = (desired fribrinogen
level, mg/dl) initial fibrinogen level (mg/dl)
multiplied by plasma volume in ml divided by 100
Bags of cryo required = mg fibrinogen required
divided by 250 mg fibrinogen per bag of
cryoprecipitate
DRUGS for BLEEDING
DISORDERS
 A. Vitamin K
A fat-soluble substance found primarily in
green leafy vegetables
Confers biologic activity upon prothrombin
and factors VII, IX, and X by participating in
their postribosomal modification
Dietary requirement is low, because it is
additionally synthesized by bacteria that
colonize the human intestine
Two natural forms
Vitamin K1 (Phytonadione)
Found in food
Oral/parenteral form
IV administration should be slow
Currently administered to all newborns
to prevent the hemorrhagic disease of
vitamin K deficiency which is especially
common in premature infants
Vitamin K2 (Menaquinone)
Found in human tissue (synthesized by
intestinal bacteria)
 A. Vitamin K
Indications for Vitamin K1 (Phytonadione)
Coagulation disorders due to faulty
formation of factors II, VII, IX, and X and
when caused by vitamin K deficiency or
interference with vitamin K activity:
Anticoagulant-induced prothrombin
deficiency caused by coumarin or
indanedione derivatives
Prophylaxis and therapy of
hemorrhagic disease of the newborn
Hypoprothrombinemia due to
antibacterial therapy
Hypoprothrombinemia secondary to
factors limiting absorption or synthesis
of vitamin K
 Medication for
Anti-coagulant induced prothrombin
deficiency; prophylaxis and therapy of
hemorrhagic disease of the newborn

Phytomenadione
(Hema-K)
10mg/mL per inj
#1 ampule

Sig: Administer 0.5-1 mg IM immediately

after birth.

Refill: 0

Warning: Monitor for rashes, swelling, and

tenderness on the injection site.
 Medication for
Anti-coagulant therapy for adult

Phytomenadione
(Hema-K)
10mg/mL per inj
#1 ampule

Sig: Administer 5-10 mg IM. Maximum of 20

mg.

Refill: 0

Warning: Monitor for rashes, swelling, and

tenderness on the injection site.
 B. Fibrinolytic Inhibitors
Aminocaproic acid
Similar to lysine
Synthetic inhibitor of fibrinolysis
Competitively inhibitis plasminogen
activation
Tranexamic acid
Analog of aminocaproic acid
 Medication for
Menorrhagia/Menometrorrhagia

Tranexamic acid
(Hemostan)
500 mg/5mL /inj
#24 vials

Sig: Administer 1-1.5 g (12-25 mg/kg body wt)

IV every 6-8 hours for 3-4 days

Refill: 0

Warning: Stop if GI disorders, nausea, vomiting,

anorexia, headache, impaired renal
insufficiency, hypotension occurs
 Medication for
General Surgeries

Tranexamic acid
(Hemostan)
500 mg/5mL /inj
#10 vials

Sig: Administer 0.5-1g (10-15 mg/kg body wt)

IV every 8-12 hours after immediately
after surgery

Refill: 0

Warning: Stop if GI disorders, nausea, vomiting,

anorexia, headache, impaired renal
insufficiency, hypotension occurs
 Medication for
Epistaxis in cases of recurrent
bleeding

Tranexamic acid
(Hemostan)
500 mg/capsule
#42 capsules

Sig: Take 2 capsules every 8 hours for 7 days

Refill: 0

Warning: Stop if GI disorders, nausea, vomiting,

anorexia, headache appears
 Medication for
GI hemorrhage

Tranexamic acid
(Hemostan)
500 mg/capsule
#72 capsules

Sig: Take 3 capsules every 6 hours for 4 days

Refill: 0

Warning: Stop if GI disorders, nausea, vomiting,

anorexia, headache appears
 C. Serine Protease
Inhibitors
Aprotinin
Inhibits fibrinolysis by free plasmin and
have other antihemorrhagic effects
Inhibits the plasmin-streptokinase complex
in patients who have received that
thrombolyic agent
Show to reduce bleeding by as much as
50% - from many types of surgery,
especially that involving extracorporeal
circulation for open heart proceudures
and liver transplantation
Associated with an increased risk of renal
failure, heart attack, and stroke
Associated with increased mortality
Removed from the market in 2007
FORMULA
Parenteral Iron Requirement

Body Weight (kg) X 2.3 X [15 patients Hgb (g/dL)]

+ 500 or 1000 mg (for storage)

Iron Dextran (INFed) number of vials

Volume per vial: 5mL
Stockdose: 20mg/mL
= 100mg Iron/vial
pRBC
1 unit pRBC = 150-200 mL
Transfusing the pediatric patient with 4cc/kg
will increase hemoglobin by 1g/dL
o Initial volume of 10-15 mL/kg can be
given quickly over minutes over a 4-hour
period
Tranfusing 1 unit in an adult patient will raise
hemoglobin by 1g/dL (HCT by 3%)
Duration of 2-3 hours given for pRBC
Transfuse until the target hemoglobin is
reached

Fresh Frozen Plasma

Volume per unit is 250 mL

Transfuse 10-15 ml/kg of FFP
Platelets
Give platelet concentrate: 1unit/7kg if:
o Platelet concentration < 50000 in patient
with significant bleeding
o < 20000 in a patient with no bleeding
For pediatric patient: 1 unit/5kg
o Equivalent to 5-10ml/kg
o Increases platelet by 50000

Cryoprecipitate

Give 1 unit/5kg if with prolonged aPTT

o >50 sec if with no reference value
o 10 sec > the upper limit or normal
o 20 sec > the control or with signs of DIC