Who guidelines on fluid resuscitation in children?
PEDIATRIC TRANSFUSION GUIDELINES (Approved by Medical Staff Executive Committee on 12/11/2006) I. Red Blood Cells. a. A. Reconstituted whole blood . Exchange transfusion . B. Red Blood Cells. 1. Premature infant[1-3] a. Stable, growing, Hgb < 7 g/dL . b. IRDS, without oxygen requirement, Hgb < 10 g/dL . c. IRDS, with oxygen requirement, Hgb < 12 g/dL . d.
Which patients need a transfusion?
NEW YORK STATE COUNCIL ON HUMAN BLOOD AND TRANSFUSION SERVICES GUIDELINES FOR TRANSFUSION OF PEDIATRIC PATIENTS INTRODUCTION This document combines the Council’s existing "Guidelines for Transfusion Therapy of Infants from Birth to Four Months of Age," 3rd edition, 2012, with additional guidance pertaining to older pediatric patients.
What are the guidelines for blood transfusion?
It is recommended that: Red cells are transfused at up to 5 mL/kg/h (unless there is active major bleeding) and the transfusion should be completed within 4 hours (see Chapter 4). Apheresis platelets should be used for all children <16 years old to reduce donor exposure. The typical dose for children weighing less than 15 kg is 10–20 mL/kg.
Does your patient need a transfusion?
Guideline - Transfusion Guidelines for Neonates) • Patients with specific conditions such as chronic anaemia, B12 or folate deficiency, haemoglobinopathies, Diamond Blackfan anaemia may require different transfusion thresholds and may be at risk of developing complications transfusion should be –
What are the guidelines for blood transfusion?
How do you calculate a pediatric blood transfusion?
What hemoglobin level requires a blood transfusion in children?
What is the hemoglobin goal for pediatric patients?
| Guidelines | Target Hb to maintain |
|---|---|
| Pediatrics | 11.0 g/dl or greater |
| 2007 version of the KDOQI Guidelines | |
| Adult | 11.0–12.0 g/dl |
| Pediatrics | 11.0–12.0 g/dl |
How many mL are in a unit of blood?
| Component (volume) | Contents |
|---|---|
| Whole blood (1 unit = 500 mL) | RBCs, platelets, plasma |
| RBCs in additive solution (1 unit = 350 mL) | RBCs |
| FFP or other plasma product* (1 unit = 200 to 300 mL) | All soluble plasma proteins and clotting factors |
How many units is a 6 pack of platelets?
When is pediatric transfusion needed?
- Acute loss of >15% of estimated blood volume.
- Hypovolemia not responsive to other treatment.
- Post-operative anaemia (Hgb < 10 g/dl)
- Pre-operative Hgb < 12 g/dl in presence of severe cardiopulmonary disease.
- Severe chronic anaemia with Hgb < 7 g/dl.
What is hemoglobin threshold?
What level hemoglobin requires transfusion?
What is MCH in a CBC with differential?
What is nadir hemoglobin?
Who severity classification of anemia?
Is maternal blood safe for transfusion?
Use of maternal blood for transfusion is not recommended in the absence of a specific medical indication, and blood from the father or another relative holds no advantage and may pose additional risks. Directed donation from any blood relative, including the mother, carries an added risk of immune complications, such as alloimmunization to. HLA antigens and TA-GVHD. It is important that a cellular component from a blood relative, and whenever the recipient and donor are members of the same genetically homogeneous group, be irradiated to prevent TA-GVHD. See the Council’s “Guidelines for Irradiation of Blood Components,” 4th edition, 2012. In the scenario of a mother donating for her child, there is also the potential risk of transfusion-related acute lung injury (TRALI) due to maternal HLA and/or neutrophil antibodies directed against the child’s white blood cells. Paternal blood for transfusion poses the risk of a missed private antigen/antibody incompatibility against an RBC antigen that would not be detected in routine screening. Therefore, a full crossmatch should be performed.
What are the complications of chronic transfusion therapy?
major complication of chronic transfusion therapy in SCD and other hemoglobinopathies is alloimmunization to red cell antigens. The most common clinically significant antibodies encountered are to Rh (E, C) and Kell antigens. Manifestations of delayed hemolytic transfusion reactions can sometimes mimic features of a painful crisis in SCD. It is important to obtain a red cell antibody history carefully, because many antibodies may be transient and not detectable at all times. If red cell antibodies have developed, the patient’s physician should be informed, including which antibodies have been made. It is recommended that the patient’s parent(s) also be informed.
What is intrauterine RBC?
Intrauterine RBC and platelet transfusions are usually considered for severe fetal anemia due to intrauterine blood loss of either a hemorrhagic or immuno- hematologic nature, such as severe Rh hemolytic disease or severe fetal thrombocytopenia associated with fetal/neonatal alloimmune thrombocytopenia (FNAIT). RBCs should be as fresh as possible, group O, hemoglobin S negative, crossmatch compatible with the mother’s serum, and have an adjusted hematocrit (70%-80%) and RBC mass intended to achieve the desired therapeutic effect while minimizing the volume used. In the case of FNAIT, platelets should be either crossmatch compatible or negative for the antigen to which the mother has an antibody. Additionally, intrauterine RBC and platelet transfusions should be CMV reduced risk (seronegative and/or leukoreduced) and irradiated. Any blood component transfused during the postnatal hospitalization, whether an exchange transfusion, supplemental RBC transfusion, or platelet transfusion, should also be irradiated. See Section VIII.C. (page 16).
Is transfusion therapy good for SCD?
There have been several observational studies and clinical trials that have demonstrated the benefit of transfusion therapy for the prevention and management of some complications associated with SCD. This is particularly true for chronic transfusion therapy for the prevention of initial and recurrent stroke in patients at high risk. The numbers of trials for various complications are limited; therefore, recommendations for transfusion are frequently based on expert consensus (see Table 3, page 21). There are several conditions for which transfusion is not recommended; these include uncomplicated painful crisis, asymptomatic anemia, acute renal failure, and priapism, unless associated with surgery.
What is hyperhemolytic syndrome?
Hyperhemolytic syndrome is a sudden or acute drop of hemoglobin below the pre-transfusion value following a transfusion. There is accelerated destruction of both autogeneic and donor red blood cells. Alloantibodies with or without autoantibodies to red cell antigens are often seen, but the absence of new alloantibodies does not rule out hyperhemolysis. The syndrome has occurred even after the transfusion of phenotypically-matched RBCs and is often associated with reticulocytopenia.
10.3: Transfusion of infants and children
Transfusion is performed much less often in older infants and children.
10.3.1: Paediatric intensive care
The TRIPICU randomised controlled trial in stable critically ill children by Lacroix et al. in 2007 found that a restrictive Hb transfusion trigger (70 g/L) was as safe as a liberal Hb trigger (95 g/L) and was associated with reduced blood use. It remains uncertain whether this can be extrapolated to unstable patients.
10.3.2: Haemato-oncology patients
Children undergoing treatment for malignancy are generally transfused in a similar manner to adult patients. A red cell transfusion trigger of 70 g/L is appropriate for clinically stable patients without active bleeding.