The American College of Physicians (ACP) developed an algorithm for red blood cell transfusions in a patient with persistent anemias.
replace intravascular volume with crystalloid solution; identify and treat causes of hypovolemia
normovolemic AND deficient in iron, folate and/or vitamin B12
replace whatever is deficient
normovolemic AND renal insufficiency
treat with erythropoietin with iron as needed
normovolemic AND being treated with zidovudine AND serum erythropoietin level low
normovolemic AND symptomatic for anemia
transfuse allogeneic red blood cells
normovolemic AND asymptomatic for anemia
monitor the patient; no transfusion necessary
• Persistent hypovolemia probably will not be solved by a crystalloid infusion. The cause needs to be identified and treated.
• If the patient has source of blood loss, then these should be treated.
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Specialty: Clinical Laboratory