blood transfusions- lu6

8/8/2019 Blood Transfusions- LU6

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BLOOD TRANSFUSIONS

UP-PGHDept. of Pediatrics



Blood components and transfusionsfrequent ly are lifesaving.

Transfusion guide lines presented arebased on those formu lated b y thePediatric Hemotherap y Committee of

the American Association of BloodBanks



Red Blood Cell Transfusions

RBCs are transfused to increase the

oxygen-carr ying capacit y of the b loodand maintain tissue ox ygenation.



G uidelines for Pediatric RBC Transfusions

Children and Adolescents

Acute loss >25% circu lating b lood vo lumeHgb < 8.0 g/dL in perioperative periodHgb < 13.0 g/dL and severe cardiopu lmonar y disease

Hgb < 8.0 g/dL and s ymptomatic chronicanemiaHgb < 8.0 g/dL and marrow fai lure



I nfants within First 4 months of Life

Hgb < 13.0 g/dL and severe pu lmonar y

diseaseHgb < 10.0 g/dL and moderate pu lmonar y diseaseHgb < 13.0 g/dL and severe cardiac diseaseHgb < 10.0 g/dL and major surger yHgb < 8.0 g/dL and s ymptomatic anemia



Transfusions ma y be given more

stringent ly to chi ldrennorma l Hgb leve ls are lower in hea lthy chi ldren than in adu lts

chi ldren shou ld be ab le to compensatebetter for RB C loss



Most important measures in the Treatment of acute hemorrhage are:1. to contro l the hemorrhage

2. to restore tissue with cr ysta lloid and/or co lloid so lutions

Then, if the estimated b lood loss is greater than 25% of the circu lating b lood vo lume(i.e., >17 mL/kg) and the patient¶s conditionremains unstab le, RB C transfusion ma y beindicated.



Factors to be considered in RBCtransfusions:

1. patient¶s signs and s ymptoms and functiona l capacities

2. presence of cardiorespirator y, vascu lar andcentra l nervous s ystem disease

3. course and anticipated course of anemia

4. a lternative therapies such as recombinant humaner ythropoietin (EPO) which is known to reduce RB Ctransfusions and to improve the overa ll condition of chi ldren with chronic rena l insufficienc y.



For neonates, RB Cs are genera lly given tomaintain a Hgb va lue desirab le for eachneonates c linica l status.

During the 1st wk of life, a ll neonatesexperience a dec line in circu lating RB C masscaused both b y ph ysio logic factors and insick premature infants, b y ph lebotom y bloodlosses.



In hea lthy infants, the nadir Hgb va luerare ly fa lls be low 9 g/dL at an age of

10-12 wk. ph ysio logic drop does notrequire BT.infants 1.0 -1.5 kg BW Hgb fa lls

to 8 g/dL

< 1.0 kg Hgb fa lls to 7 g/dL



P T re lies on the liver as the primar y siteof EPO production during the 1st wks of

lifeLiver is less responsive than kidne ys toanemia and tissue h ypoxia.



P T infant show s luggish EPO responseto fa lling Hct va lues.

Low p lasma EPO leve ls provide arationa le to use recombinant EPO inthe treatment of anemia of prematurit y.Proper doses of EPO and ironeffective ly stimu late neonata l er ythropoiesis.



In neonates with severe respirator y disease,and those requiring re lative ly large quantitiesof ox ygen and venti lator support, give b loodto increase hgb to above 130 g/L (Hct >40%).

Transfused RB C contains adu lt Hgb, andwith their superior interaction with 2,3-diphosphog lycerate (2,3-DPG) this leads to

better ox ygen off loading than that of feta l Hgb, providing optima l oxygen de liver y throughout the period of diminishedpu lmonar y function.



Maintain Hgb va lue above 130 g/L (Hct

>40%) in neonates with severe cardiacdisease leading to either c yanosis or congestive heart fai lure.



For neonates facing major surger y, Hgb >100g/dL (Hct >30%) because of the limitedabi lity of a neonate¶s heart, lungs, andvascu lature to compensate for anemia

Feta l Hgb has inferior off loading of theoxygen because of the diminished interaction

between feta l hemog lobin and 2,3-DPG; andthe deve lopmenta l impairment of neonata l rena l, hepatic and neuro logic function.



E ffects of Low RBC

tach ypnea, d yspnea, apnea

tach ycardia, brad ycardiafeeding difficu lties

letharg y

BT!



p RBC transfusion

Usua l dose: 10-15 mL/Kg

Neonates: packed RB C concentrate(Hct 70-90%)²infused s lowly 2-4hr ata dose of about 15mL/kg



Increase in p lasma K+ leve l occurs in RB Cunits during extended storage.

After 42 da ys of storage, p lasma K+ leve lsare = 50 mEq/L (0.05 mEq/mL)Examp le: 1 kg infant transfused with 15m l/kgof p RB C (Hct 80%) wi ll receive 3 m l of

extrace llular f luid that contains on ly a 0.15mEq of K+ and wi ll be transfused s lowly.



Platelet Transfusions

G uidelines for Pediatric PlateletTransfusions

Children and AdolescentsPL Ts < 50 x 10 9/L and b leedingPL Ts < 50 x 10 9/L and invasive procedurePL Ts < 20 x 10 9/L and marrow fai lure withhemorrhagic risk factors

PL Ts < 10 x 10 9/L and marrow fai lure withouthemorrhagic risk factorsPL Ts at an y count, but with PL T dysfunction p lusbleeding or invasive procedure



I nfants within 1st 4 months of life

PL Ts < 100 x 10 9/L and b leedingP lTs < 50 x 10 9/L and invasive procedurePL Ts <20 x 10 9/L and c linica lly stab lePL Ts < 100 x 10 9/L and c linica lly unstab le

PL Ts at an y count, but with PL T dysfunctionplus b leeding or invasive procedure



Goa l: Raise p late let count > 50 x 10

9/L (up to 30 kg infusing 10 m l/Kg),maximum of 6 poo led who le b lood-derived p late let units or 1 apheresisunit , as fast drip.



Fresh Frozen PlasmaTransfusions

G uidelines for Pediatric FFP Transfusions

I nfants , Children , Adolescent

Severe c lotting factor deficienc y and b leeding Severe c lotting factor deficienc y and invasiveprocedureEmergenc y reversa l of warfarin effectsDilutiona l coagu lopath y and b leeding

Anticoagu lation protein (A T -III, protein C and S )rep lacementP lasma exchange rep lacement f luid to thromboticthromboc ytopenia



Transfused to rep lace c linica lly

significant deficiencies of p lasmaproteins for which more high ly purifiedconcentrates are not avai lab le.

dose: 15m l/kg



Indications for FFP in neonates

1. reconstitution of RB C concentrates to simu latewho le b lood for use in massive transfusions(exchange transfusion or cardiovascu lar surger y)

2. hemorrhage secondar y to vitamin K deficienc y

3. disseminated intravascu lar coagu lation withbleeding

4. b leeding in congenita l coagu lation factor deficienc y when more specific treatment is either unavai lab le or inappropriate.



The use of proph ylactic FF P

transfusions to prevent intraventricu lar hemorrhage in premature infant is notrecommended.

The use of FF P in neonata l hyperviscosit y s yndrome isunnecessar y because safer co lloidso lutions are avai lab le.



CRYOPR E CIPITAT EUsed when treating b leeding infants,

cr yoprecipitate - sma ll vo lume infusionHowever, it on ly contains fibrinogen andfactors V III and X III NOT effective for treating b leeding in infants of mu ltiple c lotting

factor deficiencies despite the convenienceof sma ll vo lume infusion.



Neutro p hil ( G ranulocyte)Transfusions

Considered when neutropenic patients

continue to die of progressive bacteria l and funga l infection despite the optima l use of antimicrobia l agents andrecombinant m ye loid growth factors.



Neutro p hil ( G ranulocyte)Transfusions

Neonates and infants weighing < 10kg ± 1-2 x 10 9/kg neutrophi ls per G TX

Lager infants and chi ldren ± tota l dose of at least 1 x 10 10 neutrophi ls

per each G TX Ado lescents ± 5-8 x 10 per G TX- a dose requiring

donors to be stimu lated with G-C SF ± G TX shou ld be given dai ly unti l either the

infection reso lves or the b lood neutrophi l count exceeds 1.0 x 10 9/L for a few da ys.



G uidelines for Pediatric G aranulocyteTransfusions

Children and Adolescent

Neutrophi ls < 0.5 x 10 9/L and bacteria l infection unresponsive to appropriateantimicrobia l therap y

Qua litative neutrophi l defect and infection(bacteria l of funga l) unresponsive toappropriate antimicrobia l therap y



I nfants within 1st and 4 months of life

Neutrophi ls , 3.0 x 10 9/L (1st wk of life) or < 10.0 x 10 9/L thereafter andfulminant bacteria l infection.



Risks of Blood Transfusions

Infections associated with BT:- C MV, H IV, t ypes of hepatitis,

retroviruses, s yphi lis, parvovirus B19,Epstein- Barr virus, Chagas diseasef luid over loadgraft versus host disease



Risks of Blood Transfusions

e lectro lyte and acid base imba lancesiron over loadincreased susceptibi lity to oxidant damage

exposure to p lasticizershemo lysis when T-antigen activation of RB Chas occurred



Thank you.

An y Questions?

blood transfusions- lu6

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