See also

The Australian Red Cross Blood Service 

Key Points

1. All blood transfusion activity within the RCH and external services must occur in compliance with the relevant hospital procedures and guidelines.
2. All patients should have consent for blood product administration recorded in the medical record prior to transfusion.
3. A blood transfusion should only be given when the expected benefits to the patient are likely to outweigh the potential hazards.

Background

This guideline is adapted from the National Blood Authority (NBA) Patient Blood Management Guidelines: Module 6 Neonatal and Paediatrics (2016) as well as the British Society for Haematology Guidelines on transfusion for fetuses, neonates and older children (2016). Local procedures or guidelines may vary. 

Assessment of transfusion requirements

• A blood product transfusion may be required to treat acute blood loss associated with surgery or trauma, or when the body cannot make enough blood cells in the case of bone marrow failure, cancer or bone marrow suppression.
• A blood transfusion should only be given when the expected benefits to the patient are likely to outweigh the potential hazards.

All patients should have consent for blood product administration recorded in the medical record prior to transfusion.

Indications for Red Blood Cell (RBC) transfusion

Table 1: Indications for red blood cell transfusion

Indications for Platelet transfusion

Table 2: Indications for platelet transfusion in neonates

Table 3: Indications for platelet transfusion in infants and children

Platelet transfusion is NOT indicated for the following:

• Stable patients with chronic, stable, severe thrombocytopenia due to:
  
  • alloimmunisation
  • immune thrombocytopenia (ITP)
  • thrombotic thrombocytopenic purpura (TTP)
  • aplastic anaemia or
  • myelodysplastic syndrome (MDS)
    These patients should be observed without prophylactic platelet transfusions and should receive platelet transfusions only with clinically significant bleeding

• Bone marrow aspirate and trephine biopsy
• Intravenous cannula insertion

 Indications for Fresh Frozen Plasma (FFP)

FFP is appropriate for the following:

• Acute bleeding in the setting of significant coagulopathy
• Warfarin reversal, in the presence of significant or life-threatening bleeding or prior to emergency surgical procedures
  
  • Given in addition to vitamin K
  • NOTE: Vitamin-K dependent clotting factor concentrates (eg prothrombinex) may be given instead of FFP for bleeding secondary to warfarin or emergency warfarin reversal.
• Liver disease, with clinically significant bleeding in the context of coagulopathy post liver transplantation.
• Acute disseminated intravascular coagulopathy (DIC) with bleeding and significant coagulopathy
• During massive transfusion or cardiac bypass for the treatment of bleeding
• Plasma exchange for the treatment of TTP
• Specific factor deficiencies where a factor concentrate is not available

FFP is NOT indicated for the following:

• The correction of minor coagulation abnormalities (minor prolongation of the INR/APTT) in the non-bleeding child
• Liver disease when there are minor coagulation abnormalities and no-bleeding
• For reversal of a INR <2.0 in patients undergoing minor procedures
   
  

Indications for Cryoprecipitate

Cryoprecipitate is indicated for:

• Active bleeding and fibrinogen level <1.5 g/L 
• During massive transfusion or cardiac bypass, for the treatment bleeding when the  fibrinogen level <1.5 g/L or there is hyperfibrinolysis
• Acquired fibrinogen deficiency or acute DIC when there is significant bleeding and the fibrinogen <1.0 g/L
• Prior to an invasive procedure when the fibrinogen <1.0 g/L and there is a risk of significant bleeding associated with the surgery or it is at a critical site (eg neurosurgery or eye surgery)

Cryoprecipitate is NOT indicated for the following:

• Non-bleeding children with mildly reduced fibrinogen levels
• Liver disease when there are minor coagulation abnormalities and no active bleeding 
  

Management - Transfusion volumes and rates

• In neonates and children less than 20 kg, transfusion volumes should be calculated based on weight and prescribed in mLs
• In children greater than 20 kg, calculate and prescribe the transfusion volume with consideration to pack sizes 
• For RBC transfusion, prescribe a single unit followed by clinical reassessment to determine additional transfusion requirements
• For platelet transfusions, the usual platelet dose in an adult is one adult unit
• All transfusions must be completed within 4 hours of spiking a pack

 Table 4: Transfusion volumes and rates

Blood product modifications

Request the appropriate blood component and special requirements:

• Irradiated blood products should be given to: 
  • All immuno-compromised patients, including all immunology patients, oncology patients, neonates, preterm and low birth weight neonates, neonates with cardiac disease and directed blood donations to prevent graft-versus host disease.
• CMV negative products:
  • Leucocyte depleted blood products, are considered an acceptable alternative to CMV seronegative products at RCH
  • CMV negative products are only indicated for neonatal exchange transfusion, transfusions to preterm and term neonates up to 28 days post term, pregnant women and patients with Severe Combined Immunodeficiency Disease (SCID) who are CMV negative. 
• Phenotype matched red blood cells:
  • Indicated for chronically transfused patients or patients with red cell alloantibodies
• Cryodepleted FFP
  • May be requested for patients with Thrombotic Thrombocytopenic Purpura (TTP), although FFP may be as effective.
• IgA deficient products
  • Patients with IgA deficiency who have developed an anti-IgA antibody 
• HLA matched
  • For children with immunological refractory thrombocytopenia 
    

Parent information sheet

Kids Health Info Factsheet - blood product transfusions 

Last updated March 2018