The Indian Journal of Pediatrics

, Volume 66, Issue 3, pp 307–317 | Cite as

Pediatric transfusion therapy: Practical considerations

Basic and Behavioural Sciences

Abstract

Over the past decade, safety of blood has increased tremendously because of better donor screening as well as testing of the units for transmissible diseases. Component therapy has allowed more effective and economic use of blood. Whole blood is rarely used; instead, packed red cells, platelets, and fresh frozen plasma (FFP) are the most common components used. These products are further refined using irradiation and microaggregate filters and in the case of FFP, viral inactivation. Irradiation prevents transfusion-associated graft versus host disease, whereas microaggregate filters remove leukocytes, decreasing the rates of alloimmunization, febrile nonhemolytic (FNH) reactions, and cytomegalovirus (CMV) transmission. Autologous donation in older children probably provides the safest blood as far as transmissible diseases are concerned. More families request a directed donation and solicit physician help in deciding as well as making arrangements for autologous and/or directed donations.

Transfusions of blood and blood components in children are often challenging and require a knowledge of physiologic changes in hemoglobin and blood volumes during different ages. The unique needs of neonates, immunocompromised patients, and patients with congenital hemolytic anemia (sickle cell, thalassemia) mandate that the pediatrician have an appropriate knowledge of transfusion volumes and choice of blood product as well as indications for transfusion.

Key words

Transfusion Anemia Packed red cell, Platelet 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Blood and Components. In: Vengelen-Tyler V (ed)Technical Manual, 12 edn. Bethesda, The American Association of Blood Banks. 1996; 135–157.Google Scholar
  2. 2.
    Luban NL. Management of pediatric transfusions.Vox Song 1994; 67: 229–233.Google Scholar
  3. 3.
    Leukocyte reduction for the prevention of Transfusion-Transmitted Cytomegalovirus (TT-CMV).Association Bulletin 97-2. American Association of Blood Banks. 1997.Google Scholar
  4. 4.
    Kevy SV, Gorlin JB. Red cell transfusion. In: Nathan, DG and Orkin SH (eds.).Nathan and Oski's Hematology of Infancy and Childhood, 5 edn. Philadelphia. WB Saunders 1998; 1784–1801.Google Scholar
  5. 5.
    Jayabose S, Tugal O, Ruddy Ret al. Transfusion therapy for severe anemia.Am J Pediatr Hematol Oncol 1993; 15: 324–327.PubMedGoogle Scholar
  6. 6.
    Donaldson MD, Seaman MI, Park GR. Massive Blood Transfusion.Brit J Anaesth 1992; 69: 621–630.PubMedCrossRefGoogle Scholar
  7. 7.
    Breiter SN and Luban NLC. Appendix: Transfusion Formulas. In: Kasprisin DO and Luban NLC (eds).Pediatric Transfusion Medicine Volume II. CRC Press, 1987; 177–189.Google Scholar
  8. 8.
    Buchanan GR. Hematologic supportive care of the pediatric cancer patient. In: Pizzo PA and Poplack DG (eds.).Principles and Practice of Pediatric Oncology, 3 edn. Lippincott Raven 1997; 1051–1068.Google Scholar
  9. 9.
    Manno CS. What's new in transfusion medicine?Pediatr Clin N Amer 1996; 43: 793–808.CrossRefGoogle Scholar
  10. 10.
    Leukocyte reduction and ultraviolet B irriation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. The Trial to Reduce Alloimmunization to Platelets Study Group.N. Engl J Med 1997; 337: 1861–1969.Google Scholar
  11. 11.
    Strauss RG. Blood and blood component transfusions. In: Behrman RE, Kliegman RM and Arvin AM (eds.).Nelsons Text Book of Pediatrics. 15 ed. WB Saunders, 1996; 1417–1421.Google Scholar
  12. 12.
    Gaydos LA, Frierich EJ, Mantel Net al. The quantitative relation between platelet count and hemorrhage in patients with acute leukemia.N Engl J Med 1962; 266: 905.PubMedCrossRefGoogle Scholar
  13. 13.
    Practice Guidelines for blood component therapy: A report by the American Society of Anesthesiologists Task Force on Blood Component Therapy.Anesthesiology 1996; 84: 732–747.CrossRefGoogle Scholar
  14. 14.
    Rebulla P, Finazzi G, Marangoni Fet al. A multicentre randomized study of the threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell' Adulto.N Engl J Med 1997; 337: 1870–1875.PubMedCrossRefGoogle Scholar
  15. 15.
    Barrera R, Mina B, Huang Yet al. Acute complications of central line placement in profoundly thrombocytopenic cancer patients.Cancer 1996; 78: 2025–2030.PubMedCrossRefGoogle Scholar
  16. 16.
    Ratnoff OD. Some therapeutic agents influencing hemostasis. In: Cloman RW, Hirsh J, Marded VJ, Salzman EW (eds).Hemostasis and Thrombosis. Basic Principles and Clinical Practice. 1994; 1104–1133.Google Scholar
  17. 17.
    Kemmotsu H, Joe K, Nakamura Het al. Predeposited autologous blood transfusion for surgery in infants and children.J Pediatr Surg 1995; 30: 659–661.PubMedCrossRefGoogle Scholar
  18. 18.
    Mayer MN, de Montalembert M, Audat Fet al. Autologous blood donation for elective surgery in children weighing 8–25 kg.Vas-Sang 1996; 70: 224–228.CrossRefGoogle Scholar
  19. 19.
    Means LJ, Ferrari LR, Fisher QAet al. Evaluation and preparation of pediatric patients undergoing anesthesia. Section on anesthesiology.Pediatrics 1996; 98: 502–508.Google Scholar
  20. 20.
    Luban NLC. Cytomegalovirus. In: Anderson KJ, Ness PM (eds).Scientific Basis of Transfusion Medicine. Implication for Clinical Practice. Philadelphia: WB Saunders 1994.Google Scholar
  21. 21.
    Strauss RG. Transfusion therapy in Neonates.Am J Dis Child 1991; 145: 904–911.PubMedGoogle Scholar
  22. 22.
    Doyle JJ. The role of erythropoietin in the anemia of prematurity.Semin-Perinatol 1997; 21: 20–27.PubMedCrossRefGoogle Scholar
  23. 23.
    Vichinsky E, Lubin BH. Suggested guidelines for the treatment of children with sickle cell anemia.Hematol Oncol Clin North Am 1987; 1: 483–501.PubMedGoogle Scholar
  24. 24.
    Porter JB, Herhns ER. Transfusion and exchange transfusion in sickle cell anemias with particular reference to iron metabolism.Acta Hematol 1987; 78: 198.Google Scholar
  25. 25.
    Embury SH. Sickle cell disease. In: Hoffman R, Benz EJ, Shattil SJet al. (eds.).Hematology Basic Principles and Practice, 2nd edn. Churchill Livingstone 1995; 611–647.Google Scholar
  26. 26.
    Adams RJ, McKie VC, Hsu Let al. Prevention of first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial doppler ultrasonography.N Engl J Med 1998; 339: 5–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Schwartz E, Benz EJ, Forget BG. Thalassemia syndromes. In: Hoffman R, Benz. EJ. Shattil SJ (eds).Hematology Basic Principles and Practice 2 edn. Churchill Livingstone 1995; 586–610.Google Scholar
  28. 28.
    Barnard DR, Feusner JH, Wolff LJ. Blood component therapy. In: Ablin AR (ed).Supportive Care of Children with Cancer: Current Therapy and Guidelines from the Children's Cancer Group, 2 edn. Baltimore: The Johns Hopkins University Press. 1997; 37–46.Google Scholar
  29. 29.
    Schreiber GB, Busch MP, Kleinman SHet al. The risk of transfusion-transmitted viral infections.N Engl J Med 1996; 334: 1685–1690.PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 1999

Authors and Affiliations

  1. 1.Pediatrics/Human Development, B401 Clinical CentreMichigan State UniversityEast Lansing

Personalised recommendations