There are three primary blood products that are often transfused in traumatic brain injury: packed red blood cells (pRBCs), platelets, and plasma.
For pRBCs, hemoglobin thresholds for transfusion in anemia should be set at 7 g/dl.
Higher threshold is warranted only when the patient is clinically symptomatic.
For platelets, transfusion thresholds should be at least 50,000/mm(3) for patients without and 100,000/mm(3) for patients with evidence of hemorrhage. Reversal of antiplatelet therapy with platelet transfusion is advisable only in patients with active bleeding. Tests for platelet function are helpful in determining an adequate platelet transfusion in these situations.
Fresh frozen plasma transfusion for correction of warfarin-induced coagulopathy is also advisable in patients with active bleeding. If available, activated factor VII can be used in refractory cases. Prothrombin complex concentrates are also another alternative in refractory situations. Transfusion goals for patients with evidence of hemorrhage should be an International Normalized Ratio of 1.3 or less 1).