If the plan was to give two units but the guideline says otherwise, what is the recommended initial approach?

• A. Start with one unit, draw labs, and go from there
• B. Give two units immediately
• C. Don’t transfuse
• D. Wait for physician instructions

Answer: (A)

Start with a single unit and reassess with labs and the patient’s clinical response before deciding about a second unit. This follows a restrictive transfusion approach: use the smallest amount of blood product necessary and verify improvement before giving more. After giving one unit, check hemoglobin/hematocrit, monitor vitals and symptoms, and reevaluate the need for a second unit based on lab results and how the patient is doing. This minimizes exposure to transfusion risks (reactions, volume overload, alloimmunization) while still addressing the patient’s oxygen-carrying needs. Giving two units immediately bypasses this important check, and waiting for physician instructions or avoiding transfusion altogether may not align with the patient’s current needs.