BLOOD AND PLATELET TRANSFUSIONS
Always check front sheet in oncology patient notes before prescribing any blood product
Before transfusion
1- Explain indications for blood products to parents
2- Document indications and verbal consent
3- If previous reactions to blood products have occurred, pre-medicate with chlorphenamine (oral or IV), if
severe with hydrocortisone 4 mg/kg IV
BLOOD TRANSFUSION
When to transfuse
1-Oncology children
If haemoglobin ≤70 g/L or if >70 g/L and symptomatic or unstable, transfuse
If having radiotherapy, transfuse if Hb <110 g/L
If oncology patient has potential to require a bone marrow transplant give hepatitis E –ve leucodepleted
blood, unless already identified as requiring irradiated products
2-PICU patients
Hb transfusion trigger of 70 g/L in stable critically ill children
If symptomatic anaemia or impaired cardiorespiratory function, transfuse at higher threshold
3-Non-oncology children
If haemoglobin <60 g/L or >60 g/L and symptomatic
Target Hb and volume to be transfused
Aim for target haemoglobin of 120 g/L or for 100 g/L if initial haemoglobin <60 g/L
In newly diagnosed patients with leukaemia/profound anaemia, aim for target Hb 80–90 g/L
Calculate volume to be given as: (round to nearest unit)
=[Target Hb – actual Hb (g/L)] × weight (kg) × 0.4 mL
Total volume should not exceed 20 mL/kg
Rate of infusion
Give total over 3–4 hr. Max rate 5 mL/kg/hr
If Hb <60 g/L, give blood over 4–8 hr
(each unit must be used within 4 hr once removed from fridge)
If concerns regarding fluid overload give furosemide 1 mg/kg oral if tolerated, or IV half-way through
Use irradiated blood if
Allogenic bone marrow transplant (BMT) from start of conditioning regimen
Allogenic BMT donors
If <7 days pre-harvest for autologous BMT and stem cell transplant patients (e.g. stage IV
neuroblastoma)
Hodgkin’s disease or if patient has received fludarabine
Children with severe immunodeficiency (e.g. SCID)
HLA-matched platelets
For high risk neonates e.g. post intrauterine transfusion
PLATELET TRANSFUSION IN ONCOLOGY CHILDREN
Transfuse platelets if platelet level
<10 × 109
/L oncology children except brain tumour
<20 × 109
/L oncology children except brain tumour and unwell
<30 × 109
/L brain tumour
<50 × 109
/L brain tumour and unwell
<50 × 109
/L for lumbar puncture
Dosage and rate
• <15 kg: 15 mL/kg round off the nearest unit
• ≥15 kg: one pack
• Transfuse within 15–30 min
FRESH FROZEN PLASMA
• For bleeding in disseminated intravascular coagulopathy (DIC) when INR >1.7
• 12−15 mL/kg
• 10−20 mL/kg/hr
CRYOPRECIPITATE
• For bleeding with DIC with fibrinogen <1.5 g/L