Tuesday, October 14, 2014

Blood Transfusion Guidelines in Neonates and Children- Red Cell Transfusion

Red Blood Cell transfusion is a common process in Neonatal Intensive care Unit, Pediatric Intensive care and in sick children. A guideline on when to give blood transfusion are provided below. These guidelines are derived from Worldwide accepted textbook - Nelson and Cloherty

Tranfusion Guideleines For Premature Infants- Cloherty

1.  Asymptomatic infants with Hct  less than 21 % and reticulocytes  less than 100, 000/UL (2%)

2. Infants with Hct less than 31% and any of below

  • hood O2 less than 36% or mean airway pressure less than 6 cm H2O by CPAP or IMV  
  • more than 9 apneic and bradycardic episodes per 12 h or 2/24 h requiring bag and mask ventilation while on adequate methylxanthine therapy 
  • HR more than 180/min or RR more then 80/min sustained for 24 h
  • Weight gain of less than 10 g/d for 4 d on 100 Kcal/kg/d 
  • Having surgery


3. Infants with Hct less than 36% and requiring more than 35% O2 or mean airway pressure 6-8 cm H2O by CPAP or IMV


CPAP = continuous positive airway pressure by nasal or endotracheal route; HR = heart rate; Hct = hematocrit; IMV = intermittent mandatory ventilation; RR = respiratory rate. From the multicenter trial of recombinant human erythropoietin for preterm infants.
Source: Data from Straus RG. Erythropoietin and neonatal anemia (Editorial). N Engl J Med 1994;330:1227.



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 GUIDELINES FOR PEDIATRIC RED BLOOD CELL TRANSFUSIONS [ Nelson Textbook 19th Edition]

CHILDREN AND ADOLESCENTS

   Acute loss of > 25% of circulating blood volume
   Hemoglobin < 8.0 g/dL[†] in the perioperative period
   Hemoglobin < 13.0 g/dL and severe cardiopulmonary disease
   Hemoglobin < 8.0 g/dL and symptomatic chronic anemia
   Hemoglobin < 8.0 g/dL and marrow failure
INFANTS ≤ 4 MO OLD

   Hemoglobin < 13.0 g/dL and severe pulmonary disease
   Hemoglobin < 10.0 g/dL and moderate pulmonary disease
   Hemoglobin < 13.0 g/dL and severe cardiac disease
   Hemoglobin < 10.0 g/dL and major surgery
   Hemoglobin < 8.0 g/dL and symptomatic anemia


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