Recent Guidelines for Blood and Blood Products Transfusion in Children

Abstract

Administration of blood components and expected response Component Comment Response Packed Red Cells (PRBCs) for neonates and infants - transfused within 4 hours of removal from designated temperature- controlled storage (4±2˚C) Neonatal Exchange transfusion: - Plasma reduced whole blood in CPD - Dose: 80-100 ml/kg (for anemia), 160-200 ml/kg (for hyperbilirubinemia) - rate: depends on stability of the patient Small volume transfusions: - Red cells in additive solution (SAG-M) - Dose: 10-20ml/kg - rate: 5ml/kg/h Exchange transfusion: - 80-100ml\kg: removes 75% of red cells - 160–200 ml/kg, removes up to 50% of intravascular bilirubin. PRBCs transfusion for children - Dose: Vol (ml) = desired Hb rise (g/dl) x weight (kg) x 5 - rate 5 ml/kg/h (max rate: 150ml/hr), 2 ml/kg/h in patients with severe chronic anemia Every 5 mL/kg increases the Hb concentration by about 1 g/dl Platelets SDPis used for children <16 years - Dose: Children <15 kg: 10-20 ml/kg Children > 15 kg: single apheresis or concentrate of 300ml volume - rate 10-20ml/kg/h - not be transfused through sets already used to administer other blood components In neonates and children, 10-20 ml/kg of platelets (RDP or SDP) should result in a 100-200×109\l increment FFP - Thawedjust prior to transfusion, thawing takes 15-30 min, then cannot be re-frozen - If stored at 22 ±2 ˚C post-thawing, transfusion must be completed within 4 h of thawing - If stored at 4 ±2 ˚C post thawing, transfusion must be completed within 24 hof thawing - Dose: 10-15 ml/kg in neonates\ 10-20 ml\kg for children - rate 10-20 ml/kg/h When used for coagulation abnormalities, it should stop bleeding, bring the APTT and PT to the hemostatic range. (may not be achieved or may be transient) Cryoprecipitate - Methylene-blue treated, for children <16 y. - Dose is 5-10 ml/kg or 1 unit\5-10 kg (changed according to the treated condition) - 1-2 pools of 5 single-donor units (approx. volume 190 ml) may be used for larger children - rate 10-20 ml/kg/h (over 30 min) 1 unit/10 kg will increase fibrinogen level by 60-100 mg/dl. In a neonate 1 unit will increase fibrinogen by >100 mg/dl Granulocytes - 1-2×109/kg in neonates\ 1×109/kg for children - rate: slowly over 1-4 hours aim is to achieve granulocyte count above 0.5×109/l after transfusion Indications and doses of IVIG Speciality Condition Dosage Hematology Primary antibody deficiency (PAD) 0.2–0.6 g/kg every 3-4 weeks Immune thrombocytopenia (ITP) + HIV- associated ITP 0.8-1 g\kg once Primary immune deficiency (PID) patients undergoing HSCT 0.4–0.6 g/kg/month Post-transfusion purpura 2 g/kg over 2-5 days Neonatal alloimmine thrombocytopenia (NAIT) 1 g/kg once, can repeated Haemolytic disease of the newborn 0.5 g/kg, can be repeated or 1 g\kg once at 12 h post-natal age Neurology Guillian-Barré syndrome, Miller Fisher syndrome 2 g/kg over 5 days Chronic inflammatory demyelinating polyneuropathy (CIDP) 2 g/kg over 2-5 days, repeated after 6 weeks then repeated as relapses interval Myasthenia gravis, Lambert-Eaton myasthenic syndrome (LEMS) 1 g/kg/day × 2 days Acute disseminated encephalomyelitis 1 g/kg/day × 2 days Rheumatology Dermatomyositis, polymyositis 1 g/kg/day × 2 days, repeat after 6 weeks Systemic lupus erythematosus 1 g/kg/day × 2 days Kawasaki’s disease 2 g/kg once, repeat if relapse within 48 h Dermatology Pemphigus Vulgaris, Bullous Pemphigoid 2 g/kg over 2–5 days Toxic epidermal necrolysis 1–2 g/kg over 2–5 days Chronic urticarial 1–2 g/kg over 2–5 days for 3 courses Infections Neonatal sepsis 1–2 g/kg over 2–5 days Staphylococcal toxic shock/ necrotizing fasciitis 2 g/kg once