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Pediatric Transfusions
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Transfusion Medicine Service Pediatric Transfusions

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

Reconstituted Whole Blood

  1. 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
     
  2. Cardiovascular bypass surgery
  3. Extracorporeal membrane oxygenation (ECMO)
  4. Massive transfusion or acute blood loss (> 1 blood volume in 24 hours)


Red Blood Cells

  1. 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:

    a. Severe pulmonary disease
    b. Cyanotic heart disease or heart failure
    c. Severe apnea of prematurity
    d. Removal of blood for laboratory testing when the cumulative volume removed exceeds 10% of the infants 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.

  2. 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:

    a. Cerebrovascular accident
    b. Acute chest syndrome
    c. Splenic and/or hepatic sequestration
    d. Recurrent priaprism
    e. 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.


Platelets *

  1. 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

  2. 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.


Granulocytes *

  1. Bacterial sepsis in neonates < 2 weeks of age with neutrophil plus band count < 3 E+9/L.
  2. 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.
  3. Documented infection(s) unresponsive to antibiotics plus a qualitative neutrophil defect regardless of the neutrophil plus band count.


Plasma *

  1. 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.
  2. Bleeding during massive transfusion (in excess of one blood volume in less than 24 hours) not due to dilutional thrombocytopenia.
  3. Replacement therapy in Protein C or S deficiencies.
  4. Replacement therapy during therapeutic plasma exchange for disorders in which FFP is beneficial.


Cryoprecipitate *

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


Clotting Factor Concentrates

  1. Bleeding, or thrombosis, in patients with documented coagulation or antithrombotic factor deficiencies such as hemophilia A or B or antithrombin III deficiency.
  2. Severe or variant forms of von Willebrand's disease


Albumin

  1. Acute correction of hypoalbuminemia when clinically indicated
  2. Correction of hypovolemia when colloid infusion is indicated
  3. Replacement therapy in therapeutic phlebotomy or therapeutic apheresis.

* Subject to pre-transfusion review for compliance with audit criteria.

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