Can I transfuse blood to a patient with hypotension and unknown blood temperature?

Blood Transfusion with a Patient Temperature of 99.7°F

Yes, you can transfuse blood to a patient with a temperature of 99.7°F (37.6°C), as this is within the normal range and does not represent significant hyperthermia that would contraindicate transfusion. 1

Temperature Considerations for Blood Transfusion

• Blood transfusion is safe at a patient temperature of 99.7°F, as this represents only a mild elevation from normal body temperature (98.6°F/37°C) 1
• The primary temperature concern in transfusion medicine is actually hypothermia, not mild fever, especially in patients with hypotension who may require rapid transfusion 1
• Hypothermia (temperature <35°C) is associated with increased mortality, blood loss, and transfusion requirements in trauma patients 1

Blood Warming Requirements

• In all adults undergoing surgery under general or regional anesthesia, blood components should be warmed to 37°C when transfusing volumes of 500 mL or more 1
• Blood should only be warmed using approved, specifically designed and regularly maintained blood warming equipment with a visible thermometer and audible warning 1
• Blood components should never be warmed using improvisations, such as putting the pack in warm water, in a microwave, or on a radiator 1
• The greatest benefit of warming is from controlled warming of red cells (stored at 4°C) rather than platelets (stored at 22±2°C) or FFP/cryoprecipitate (thawed to 37°C) 1

Transfusion in Hypotensive Patients

• For patients with hypotension, blood transfusion is often indicated as part of resuscitation, especially when the hypotension is due to hemorrhage 1
• When transfusing hypotensive patients, consider using rapid infusion devices which typically have a range of 6-30 L/h and usually incorporate a blood-warming device 1
• External pressure devices can be used to administer a unit of red cells within a few minutes in emergency situations, but should be used with a large-gauge venous access cannula 1

Monitoring During Transfusion

• Monitor the patient's hemodynamic status throughout the transfusion, including blood pressure and heart rate 1
• The volume delivered should be monitored regularly throughout the infusion to ensure that the expected volume is delivered at the required rate 1
• For patients with hypotension, monitor for signs of end-organ perfusion including ST changes, oxygen saturation, ECG, urine output, and arterial blood gas analysis 1

Special Considerations

• If the patient's hypotension is severe (systolic BP <90 mmHg), consider damage control resuscitation strategies 1
• For patients with ongoing bleeding, aim for a hemoglobin target of 7.0-9.0 g/dL during active resuscitation 1
• Consider using tranexamic acid in the setting of massive hemorrhage, particularly with a loading dose of 1 g over 10 min followed by 1 g over 8 h 1

Pitfalls to Avoid

• Do not delay transfusion in a hypotensive patient due to mild temperature elevation (99.7°F) as this does not represent a contraindication 1
• Avoid allowing blood to cool during rapid transfusion as hypothermia worsens coagulopathy and increases mortality 1
• Do not use improvised warming methods as these can damage blood components and potentially harm the patient 1
• Remember that a 1°C drop in body temperature is associated with a 10% drop in coagulation factor function, so maintaining normothermia is critical 1