Can a patient with liver cirrhosis and hepatitis receive a blood transfusion?

From the Guidelines

Blood transfusions should only be administered to patients with cirrhosis and hepatitis by qualified healthcare professionals in appropriate medical settings, with careful consideration of the potential risks and benefits, including the risk of increasing portal pressure and exacerbating bleeding complications, as noted in the EASL clinical practice guidelines 1. When considering a blood transfusion for a patient with cirrhosis and hepatitis, it is essential to weigh the potential benefits against the risks, including the risk of transfusion-related acute lung injury, transfusion-associated circulatory overload, and allergic/anaphylactic reactions, as highlighted in the guidelines 1. Key considerations for blood transfusions in patients with cirrhosis and hepatitis include:

• Careful screening of blood products to match the patient's blood type and meet specific medical requirements
• Administration of blood products in a controlled medical setting with continuous monitoring
• Potential need for specialized blood products, such as platelets or plasma, depending on the patient's specific condition
• Restrictive packed red blood cell transfusions, with a target haemoglobin of 7-9 g/dl, may be associated with lower re-bleeding and mortality in patients with acute upper gastrointestinal bleeding, as suggested by the guidelines 1. Overall, the decision to administer a blood transfusion to a patient with cirrhosis and hepatitis should be made by qualified healthcare professionals, taking into account the individual patient's needs and medical condition, and with careful consideration of the potential risks and benefits, as emphasized in the EASL clinical practice guidelines 1.

From the FDA Drug Label

1. 2 Thromboembolic Risk/Complications There is a risk of thrombosis or disseminated intravascular coagulation when patients with acquired deficiency are treated with human prothrombin complex. Patients given human prothrombin complex should be observed closely for signs or symptoms of disseminated intravascular coagulation or thrombosis Because of the risk of thromboembolic complications, monitoring of signs and symptoms should be exercised when administering human prothrombin complex to patients with a history of coronary heart disease, patients with liver disease, or to patients at risk of thromboembolic events or disseminated intravascular coagulation

The patient has cirrhosis and hepatitis, which are both liver diseases. The label warns of a risk of thromboembolic complications in patients with liver disease. Therefore, blood transfusion with this product may not be suitable for someone with cirrhosis and hepatitis due to the risk of thromboembolic events. Caution should be exercised when considering administration of this product to patients with liver disease. The potential benefit of treatment should be weighed against the risk of complications 2.

From the Research

Transfusion Strategies in Patients with Cirrhosis and Hepatitis

• The decision to give a blood transfusion to someone with cirrhosis and hepatitis should be made on a case-by-case basis, considering the individual's specific medical condition and needs 3, 4.
• Studies have shown that patients with cirrhosis often have complex hemostatic derangements, making it challenging to determine the best transfusion strategy 5, 6.
• The use of viscoelastic testing (VET)-guided transfusions and thrombopoietin (TPO) receptor agonists may be beneficial in reducing blood transfusion requirements and improving hemostasis in patients with cirrhosis 3, 4.
• However, the efficacy of fresh frozen plasma (FFP) transfusion in enhancing thrombin generation in patients with cirrhosis and impaired conventional coagulation tests is limited, and may even worsen coagulation test values in some cases 7.

Predicting the Risk of Blood Transfusion

• A predictive model has been developed to assess the risk of transfusion in patients with cirrhosis, using factors such as prothrombin time (PT), platelet counts, and inflammatory markers 6.
• This model has shown promising effectiveness in predicting the need for blood transfusion, and may contribute to optimizing transfusion practices and improving patient outcomes.

Considerations for Transfusion

• The liver plays a pivotal role in hemostasis, and patients with cirrhosis frequently demonstrate abnormal coagulation profiles on routine laboratory tests 5.
• The utility of common hematologic tests, including the INR and aPTT, in assessing hemostatic and thrombotic risk in patients with cirrhosis is limited 4.
• Clinicians should exercise caution when interpreting laboratory results and making transfusion decisions, taking into account the complex hemostatic derangements present in patients with cirrhosis 3, 4, 5, 6, 7.