202411012233

Status:

Tags: Paed, Haematology

Transfusion in Paeds

Massive haemorrhage definition variable

• 50% blood volume replaced per hour
• 40ml/kg of blood per hour

Initially:
20-30ml/kg PC

followed by 1:1:1 of PC : FFP : plt
= 20 : 10 : 5 ml/kg

Paed specific MTP

one set of bloods Q30min
CBC & clotting every 40ml/kg blood components

7 Ts in MTP

• trigger
  • no universal trigger → use hospital criteria
• Team
• TXA
  • 10 - 30mg/kg IV
  • max of 2g
  • give over 15min
• testing
  • every 30-60min
  • every time after an MTP pack given
• Transfuse to target
  • Hb 8g/dL
    • 10ml/kg of PC ↑Hb by 2g/dL
  • fibrinogen >100mg/dL
    • 5ml/kg of cryoprecipitate ↑ Fibrinogen by 30mg/dL
  • PT <1.5
    • 10ml/kg of FFP ↑ coagualation factors by 20%
  • plt >75,000
    • 10ml/kg of apheresis plt ↑ plt by 50,000
  • ABG & clinical normal
• Temp / trouble (lethal triad, hypoCa)
  • hypoK
    • esp in children <1y & <10kg
      • use blood <7 days old
      • use washed blood
      • blood irradiated 96h before transfusion
      • larger catheters (to avoid haemolysis during transfusion)
• Termination

References

WCA024 - Paediatric anaesthesia - My worst nightmare in the operating room (youtube.com)