Transfusion Medicine Service
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
- 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)
* Subject to pre-transfusion review for compliance with audit criteria.
- 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.