Forms and Labeling
  Ordering Transfusions
  Transfusion Procedure
  Audit Procedure
  Adult Transfusions
Pediatric Transfusions
  Informed Consent
  OR Schedule
  Massive Transfusion
  Trauma Activated Transfusion Algorithm (TATA)
  Bloodloc System
  Block Release Protocol
  Available Components
Transfusion Medicine Service Pediatric Transfusions

Further Information Is Available By Contacting The Medical Director of the Transfusion Medicine Service: Zbigniew M. Szczepiorkowski, M.D. or the Blood Bank Medical Director, Nancy M. Dunbar M.D.

Red Blood Cells

  • Patients less than 4 months of (chronological) age
    • Hemoglobin < 13 g/dL (hematocrit < 40%) in neonates < 24 hours old
    • Hemoglobin < 13 g/dL (hematocrit <40%) and at least one of the following conditions:
      • Severe pulmonary disease
      • Cyanotic heart disease or heart failure
      • Severe apnea of prematurity
      • Removal of blood for laboratory testing when the cumulative volume removed exceeds 10% of the infantís blood volume in a 1-week period
    • Acute blood loss = 10% of total blood volume
    • Hemoglobin < 8 g/dL (hematocrit < 25%) in stable newborn infants with clinical manifestations of anemia
  • Patients 4 months of age and older
    • Significant preoperative anemia, hemoglobin < 8 g/dL (hematocrit < 25%) in emergency surgical cases or in non-emergency cases where an alternate, effective therapy for anemia (e.g. iron therapy in a child with iron deficiency anemia) is not practical and/or available.
    • Intraoperative blood loss = 15% of total blood volume
    • Postoperative hemoglobin < 8 g/dL (hematocrit <25%) and symptoms and signs of anemia
    • Acute blood loss with symptoms and signs of hypovolemia not responsive to crystalloid or colloid infusion
    • Hemoglobin < 13 g/dL (hematocrit < 40%) and severe pulmonary disease, cyanotic heart disease or heart failure (surgical and non-surgical).
    • Hemoglobin < 8 g/dL (hematocrit < 25%) in patients receiving chemotherapy and/or radiotherapy
    • Sickle cell disease and one of the following:
      • Cerebrovascular accident
      • Acute chest syndrome
      • Splenic and/or hepatic sequestration
      • Recurrent priaprism
    • Preparation for surgery with general anesthesia
    • Chronic congenital or acquired anemias without an expected satisfactory response to medical therapy with a hemoglobin level < 13 g/dL (hematocrit < 40%) and signs and symptoms of anemia
    • Chronic transfusion programs in selected patients with thalassemia syndromes or red cell transfusion dependent disorders.


  • Premature infants (gestational age < 37 weeks)
    • Platelet count = 50 E+9/L in a stable preterm infant
    • Platelet count = 100 E+9/L in a sick preterm infant
  • All other patients
    • Platelet count = 20 E+9/L in a patient with failure of platelet production
    • Platelet count = 50 E+9/L with active bleeding or the need for an invasive procedure in a patient with failure of platelet production
    • Platelet count = 100 E+9/L with active bleeding or the need for an invasive procedure in a patient with DIC or other coagulation abnormalities
    • Bleeding with a qualitative platelet defect and significant prolongation of the bleeding time regardless of the platelet count.


  • Bleeding, or an invasive procedure, in a patient with documented coagulation factor deficiency or a significantly prolonged PT and for whom a specific factor concentrate is not available.
  • Bleeding during massive transfusion (in excess of one blood volume in less than 24 hours) not due to dilutional thrombocytopenia.
  • Replacement therapy in Protein C or S deficiencies.
  • Replacement therapy during therapeutic plasma exchange for disorders in which FFP is beneficial.


Bleeding, or an invasive procedure, in patients with hypofibrinogenemia ( per adult criteria) or dysfibrinogenemia

Reconstituted Whole Blood

  • Exchange transfusion
    • Hemolytic disease of the newborn
    • Hyperbilirubinemia
    • Under certain clinical situations patients with sepsis and/or disseminated intravascular coagulation (DIC) may be considered for exchange transfusion
  • Cardiovascular bypass surgery
  • Extracorporeal membrane oxygenation (ECMO)


  • Bacterial sepsis in neonates < 2 weeks of age with neutrophil plus band count < 3 E+9/L.
  • Bacterial sepsis or disseminated fungal infection unresponsive to antibiotics in patients > 2 weeks of age with neutrophil plus band count < 0.5 E+9/L.
  • Documented infection(s) unresponsive to antibiotics plus a qualitative neutrophil defect regardless of the neutrophil plus band count.
* Subject to pre-transfusion review for compliance with audit criteria.

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