BLOOD TRANSFUSION IN

PEDIATRIC PRACTICE

Djajadiman Gatot
Division of Hematology and Oncology
Department of Child Health
FMUI – Dr. CMGH
BLOOD TRANSFUSION
Transfer process of blood
from donor to recipient

History of blood transfusion

15th century – idea of blood transfusion
by drinking the blood
16th century – animal  animal
17th century – animal  human
18th century – human  human (direct route)
1901 – Karl Landsteiner found the ABO blood
group
1914 – the use of anticoagulant
1937 – blood banking organization
 BLOOD
“Blut ist ein ganz besondrer Saft”
Blood is a very special fluid
Goethe, 1808
Current concept:
Blood is an Organ
• Transport system
• Defense system
• Coagulation system
 Clinical blood transfusion

 Whole blood
 Blood component (1960)
~ Erythrocyte (red blood cell)
~ Leukocyte
~ Thrombocyte (Platelet)
~ Plasma (fresh frozen)
~ Cryoprecipitate
 The advantage of transfusion
using blood component

Give only component needed

Prevent the administration of component
not needed (for safety and efficiency)
Positive impact on blood donor stock
The transfusion trigger,
when blood must be given

Acute anemia
 Hb ≤ 6 g/dL
 blood volume ↓: 30% - 40%
 Pre-operative (Hb<8g/dL)
 Chronic anemia
 Neonate with respiratory distress
 BLOOD COMPONENT

Red blood cell (RBC)

• Whole blood
 Cardiac surgery
 Massive hemorrhage/bleeding
• Packed red cell (PRC)
 Source: single donor
 Ht ~ 55%
 Symptomatic anemia
 …………rbc

• Leukocyte-depleted RBC
 filtered transfusion
 prevent: transfusion reaction, TTD and
GVHD
• Washed RBC
 diminished: antibody, K+, leukocyte
 given for: repeated transfusion, antibody
present, PNH
 ............ rbc

• Frozen-thawed, deglycerolized RBC

 remove glycerol, plasma, anticoagulant,
platelet debris and leukocyte
 for “antigen-matched” transfusion
• Irradiated RBC
 eliminate lymphocyte
 prevention of GVHD
 Dose of RBC for transfusion
Patient’s Hb Amount of RBC
(g/dL) (given within 3-4 hrs)
-------------------------------------------------------------------------------
7-10 10 mL/kg.bw
5-7 5 mL/kb.bw*
< 5, CF (-) 3 mL/kg.bw*
< 5, CF (±) 3 mL/kg.bw+furosemide
< 5, CF (+) exchange transfusion
-------------------------------------------------------------------------------
CF= cardiac failure
*may be repeated at interval 6-12 hrs
 Volume of blood needed

Whole blood:
BW(kg) x 6 x (Hbdesired – Hbobserved)

PRC(2/3 of whole blood):

BW(kg) x 4 x (Hbdesired – Hbobserved)
 Platelet concentrate
(thrombocyte concentrate=TC)

 produced:
~ from1 unit of fresh whole blood, single donor
~ by thrombopheresis
 given in case of:
 bleeding with thrombocytopenia
 pre-operative preparation if platelet count low
 dosage (unit):
BW(kg) x 1/13(lt) x (1000/300)
 Granulocyte suspension
(Buffy coat)

Indicated for:
 neonates with sepsis,
granulocytes < 3000/µL
 sepsis with granulocytes < 500/µL
 granulocyte dysfunction with infection

(The AABB)
 Fresh Frozen Plasma

 Deficiency of clotting factors

 Hypovolemic shock (bleeding >>)
 Liver disease
 Immune deficiency
 Protein-losing enteropathy
Dose: 20-40 mL/kgBW
 Cryoprecipitate

 1 bag (± 20 mL) of cryoprecipitate contain:

~ 80-120 units of factor VIII
~ 150-200 mg fibrinogen
~ von Willebrand factor
~ factor XIII
 for treatment of:
 hemophilia A
 von Willebrand disease
 …………cryoprecipitate

Dosage:
 40-50 U/kgBW, loading dose
 20-25 U/kgBW, every 12 hrs
Factor VIII concentrate:
 Available as commercial product
 Contain approx. 250 U and 1000 U,
lyophilized with 10 mL diluents
 Factor IX complex
(Activated prothrombin complex)

 Contain prothrombin, factor VII, IX, X

and protein C
 For treatment of hemophilia B, liver disease
 Dosage: 80-100 U/kgBW every 24 hrs
 Albumin

Indications:
 Hypoproteinemia
 Severe burn
 Neonatal hyperbilirubinemia
Dosage: 1-3 g/kgBW
 Immunoglobulin
Indications:
 for treating specific infections,
such as varicella, hepatitis B, etc.
 immune deficiency or immunocompromise
 immune thrombocytopenic purpura (ITP)
Dosage: 1-3 mL/kgBW
Autologous blood transfusion

Indicated for:
 Patient with persistent antibody
 Refuse to receive blood from others
 Transfusion reaction

 Not always can be prevented

 Several types of transfusion reaction
 Symptoms not rarely overlapped

‫ ٭‬In case of transfusion reaction the following steps

must be anticipated:
 stop the transfusion immediately
 I.V. line should be kept running (with NaCl 0,9%)
 urgently inform the physician in charge and the
blood bank
Acute hemolytic transfusion reaction

ABO incompatibility
Symptoms: feverish, shivering, nausea,
dyspnea, chest and or abdominal
pain, oliguria, hemoglobinuria,
hypotension
severe: shock, DIC, renal failure
Slow hemolytic transfusion reaction

 present of antibody
 could be mild or severe
Non-hemolytic transfusion reaction

Fever
 Allergic reaction
 Anaphylaxis reaction
 The aim to reduce the need
of blood transfusion

By the use of:

• Hematinics for deficiency anemia
• Erythropoietin (rHuEPO)
• Granulopoietin (G-CSF, GM-CSF)
• DDAVP for mild hemophilia
Other side effects and hazards
of blood transfusion
Transmission of infectious disease:
♦ Viral hepatitis
♦ HIV/AIDS
♦ CMV
♦ Others: ~ Malaria
~ Toxoplasmosis
~ HTLV-1
~ Infectious mononucleosis
~ Creutzfeld Jacob Disease
~ Parvo virus B 19
 …………side effects

 Bacterial contamination
 Graft-versus- host disease
 Iron overload
 Pearl

 Any transfusion which is not indicated is

contra indicated
 Adequate knowledge and skill in the
transfusion medicine are needed