Packed Red Cells (PRBC)
Raises oxygen-carrying capacity, not volume, not clotting.
| Indication | Symptomatic anemia. Transfuse below Hb 7 g/dL (general), 7.5 g/dL for cardiac surgery, 8 g/dL for orthopedic surgery or known cardiovascular disease |
| Contains | Red cells in preservative; Hct ~55-65% (additive solution) or ~70-80% (CPDA-1); no platelets, no clotting factors |
| Effect | 1 unit raises Hb ~1 g/dL, Hct ~3% |
| Storage | 1-6°C; shelf life up to 42 days (additive) or 35 days (CPDA-1) |
| Clock | Start within 30 min of issue, complete within 4 hours |
Must be ABO and Rh compatible, and cross-matched.
These thresholds come directly from the 2023 AABB international RBC guideline (45 RCTs, 20,599 adult participants). The 7.5/8 g/dL exceptions are not arbitrary, they reflect the actual thresholds used in the cardiac surgery and orthopedic surgery trials that the recommendation is built on.
Platelets
Stored warm and moving, the most fragile product.
| Prophylaxis | Transfuse below 10 ×10⁹/L if non-bleeding (hypoproliferative thrombocytopenia, active chemo or allogeneic stem cell transplant) |
| Procedures | Below 50 ×10⁹/L for major non-neuraxial surgery; below 100 ×10⁹/L for neurosurgery or posterior-eye surgery |
| Dose | 1 adult pool or apheresis unit raises count ~30-50 ×10⁹/L |
| Storage | 20-24°C with continuous agitation; shelf life 5 days (7 days if pathogen-reduced); not refrigerated |
| Clock | Transfuse over 30-60 minutes at room temperature |
Do not give for cardiac bypass or spontaneous ICH without active bleeding.
Worth clarifying: the 80 ×10⁹/L figure quoted for neuraxial or epidural procedures is a long-standing anesthesia-specific convention, distinct from the 2025 AABB/ICTMG hematology guideline's lumbar puncture threshold of 20 ×10⁹/L. The two numbers answer different questions (diagnostic LP vs an indwelling epidural catheter with a much higher consequence if it bleeds), so don't be surprised if they don't match when you look them up side by side.
Fresh Frozen Plasma (FFP)
All the clotting factors, for bleeding, not for volume.
| Indication | Bleeding with multiple factor deficiency (massive transfusion, DIC, liver disease); TTP plasma exchange |
| Contains | All coagulation factors, roughly 1 IU/mL each, including labile factors V and VIII |
| Dose | 10-15 mL/kg, raises factor levels roughly 20% |
| Storage | Frozen at or below -18°C, roughly 12 months; thaw takes 20-30 min |
| Clock | Once thawed, use within 24 hours stored at 1-6°C |
ABO-compatible, opposite convention to red cells. Not first-line for warfarin reversal if PCC is available.
Cryoprecipitate
The fibrinogen concentrate. Small bag, big clot.
| Indication | Fibrinogen under 1.5 g/L with bleeding (DIC, massive transfusion); under 2 g/L in obstetric hemorrhage |
| Contains | Fibrinogen, factor VIII, factor XIII, von Willebrand factor, fibronectin |
| Per unit | At least 150 mg fibrinogen plus at least 80 IU factor VIII; a 10-unit adult pool raises fibrinogen roughly 1 g/L |
| Storage | Frozen at or below -18°C, roughly 12 months |
| Clock | Once thawed, use within 6 hours if closed system, 4 hours if open-pooled; room temperature, do not refrigerate |
Not for warfarin reversal. Not a "concentrated plasma," it's a fibrinogen concentrate specifically.
Whole Blood (LTOWB)
Balanced resuscitation in a single bag.
| Indication | Trauma or massive hemorrhage resuscitation |
| Contains | Red cells, plasma, and cold-stored platelets together; group O, low anti-A/anti-B titer |
| Volume | Roughly 500 mL, leukoreduced with a platelet-sparing filter |
| Storage | 1-6°C; shelf life 21 days (CPD) or 35 days (CPDA-1) |
| Clock | Start within 30 min of issue, complete within 4 hours |
Cold-stored platelet function falls after roughly 14 days, even though the red cells and plasma remain usable for the full shelf life.
Prothrombin Complex Concentrate (PCC)
Fast warfarin reversal. Small volume, no thawing.
| Indication | Urgent warfarin reversal with major bleeding, or before emergency surgery |
| 4-factor PCC | Factors II, VII, IX, X, plus proteins C and S |
| Dose | 25-50 IU/kg, INR-based; always co-administer IV vitamin K |
| Onset | Corrects INR within roughly 10-30 minutes |
Plasma-derived factor concentrate, not a cellular blood component. Low volume means minimal TACO (transfusion-associated circulatory overload) risk compared to FFP.
Main risk is thrombosis. Always co-give IV vitamin K. 3-factor PCC contains only low levels of factor VII and is not equivalent for warfarin reversal.
Time & Temperature
The clock starts the moment it leaves the fridge.
| Product | Clock & storage |
|---|---|
| Red cells / whole blood | Start within 30 min, finish within 4 h; store 1-6°C |
| Platelets | 20-24°C, agitated; not refrigerated |
| FFP | Thawed, use within 24 h at 1-6°C |
| Cryoprecipitate | Thawed, use within 6 h (4 h if open-pooled), room temperature, not refrigerated |
The 30-minute rule: a unit out of controlled storage for more than 30 minutes usually cannot return to stock.
Right product, right patient, right dose, right time, right documentation. Two-person bedside check, every time.
Quick Reference Card & Primary Sources
| Product | One-line reminder |
|---|---|
| PRBC | Oxygen-carrying capacity; 1 unit ≈ Hb +1 g/dL |
| Platelets | Clotting cells; store warm, agitated, 5-7 day shelf life |
| FFP | All clotting factors; 10-15 mL/kg; not first-line for warfarin reversal |
| Cryoprecipitate | Fibrinogen concentrate; 10-unit pool ≈ fibrinogen +1 g/L |
| Whole blood | Red cells, plasma, platelets together; platelet function fades after ~14 days |
| PCC | Fastest warfarin reversal; always pair with IV vitamin K |
Primary sources checked for this guide:
- Carson JL, Stanworth SJ, Guyatt G, et al. Red Blood Cell Transfusion: 2023 AABB International Guidelines. JAMA. 2023;330(19):1892-1902.
- Metcalf RA, Nahirniak S, Guyatt G, et al. Platelet Transfusion: 2025 AABB and ICTMG International Clinical Practice Guidelines. JAMA. 2025;334(7):606-617. PMID 40440268.
- AABB. Updates in Red Blood Cell Transfusion Thresholds. Patient Blood Management Bulletin, April 2024.
- AABB. New 2025 AABB Platelet Transfusion Guidelines. Summary, JournalFeed, October 2025.