Blood and platelet transfusions

BLOOD AND PLATELET TRANSFUSIONS

:ok_hand::ok_hand:Always check front sheet in oncology patient notes before prescribing any blood product
:dart::dart:Before transfusion :point_right:
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
:writing_hand:BLOOD TRANSFUSION
:thinking:When to transfuse

1-Oncology children
:bouquet:If haemoglobin ≤70 g/L or if >70 g/L and symptomatic or unstable, transfuse
:bouquet:If having radiotherapy, transfuse if Hb <110 g/L
:bouquet: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
:bouquet: Hb transfusion trigger of 70 g/L in stable critically ill children
:bouquet:If symptomatic anaemia or impaired cardiorespiratory function, transfuse at higher threshold
3-Non-oncology children
:bouquet:If haemoglobin <60 g/L or >60 g/L and symptomatic
:dart::dart:Target Hb and volume to be transfused
:chess_pawn: Aim for target haemoglobin of 120 g/L or for 100 g/L if initial haemoglobin <60 g/L
:chess_pawn: In newly diagnosed patients with leukaemia/profound anaemia, aim for target Hb 80–90 g/L
:chess_pawn: Calculate volume to be given as: (round to nearest unit)
=[Target Hb – actual Hb (g/L)] × weight (kg) × 0.4 mL
:chess_pawn: Total volume should not exceed 20 mL/kg
:dart::dart:Rate of infusion
:business_suit_levitating:t3: Give total over 3–4 hr. Max rate 5 mL/kg/hr
:business_suit_levitating:t3: If Hb <60 g/L, give blood over 4–8 hr
:point_right: (each unit must be used within 4 hr once removed from fridge)
:point_right:If concerns regarding fluid overload give furosemide 1 mg/kg oral if tolerated, or IV half-way through
:dart::dart:Use irradiated blood if
:bouquet:Allogenic bone marrow transplant (BMT) from start of conditioning regimen
:bouquet:Allogenic BMT donors
:bouquet:If <7 days pre-harvest for autologous BMT and stem cell transplant patients (e.g. stage IV
neuroblastoma)
:bouquet:Hodgkin’s disease or if patient has received fludarabine
:bouquet:Children with severe immunodeficiency (e.g. SCID)
:bouquet:HLA-matched platelets
:bouquet:For high risk neonates e.g. post intrauterine transfusion

:writing_hand:PLATELET TRANSFUSION IN ONCOLOGY CHILDREN

:dart::dart:Transfuse platelets if platelet level
:bouquet:<10 × 109
/L oncology children except brain tumour
:bouquet:<20 × 109
/L oncology children except brain tumour and unwell
:bouquet:<30 × 109
/L brain tumour
:bouquet:<50 × 109
/L brain tumour and unwell
:bouquet:<50 × 109
/L for lumbar puncture

:dart::dart:Dosage and rate
• <15 kg: 15 mL/kg round off the nearest unit
• ≥15 kg: one pack
• Transfuse within 15–30 min

:writing_hand:FRESH FROZEN PLASMA
• For bleeding in disseminated intravascular coagulopathy (DIC) when INR >1.7
• 12−15 mL/kg
• 10−20 mL/kg/hr
:writing_hand:CRYOPRECIPITATE
• For bleeding with DIC with fibrinogen <1.5 g/L