Blood Components Transfusion

Platelets Transfusion

Thrombocytopenia is a frequent complication of intensive pediatric oncology treatments, with morbidity risks tied to the rate of platelet decline, particularly when platelet counts fall below 20 × 10^9/L. Petechiae, spontaneous bleeding, and mucosal hemorrhage are typical when platelet counts are under 20 × 10^9/L, although severe spontaneous or life-threatening hemorrhages are uncommon.

When considering platelet transfusion, factors to take into account include: (1) the cause of thrombocytopenia; (2) the expected time until resolution; (3) the speed of the platelet count decrease; (4) the patient’s clinical condition, including fever, infection, mucositis, coagulopathy, or bleeding; (5) a history of severe haemorrhage; (6) any recent or upcoming surgical procedures; and (7) concurrent medications like amphotericin, enoxaparin, and tyrosine kinase inhibitors.

Platelet transfusion guidelines

Fresh Frozen Plasma

Indications

• Correction of coagulopathy due to:
  • DIC / severe sepsis
  • severe liver disease
  • major haemorrhage
  • severe vitamin K deficiency (give vitamin K as well)
  • reversal of warfarin (if prothrombin complex concentrates not available / not advised)
  • clotting factor deficiencies if specific concentrate not available
• Usually, FFP is given to correct a coagulopathy if a child is bleeding or requires a surgical Procedure.
• Occasionally warranted to correct a very severe coagulopathy in the absence of bleeding/surgery, eg new presentation of leukemia (especially AML).
• Correction of coagulopathy with FFP in other situations is rarely needed.
• FFP should not be given as a volume expander.
• Discussion with a consultant hematologist is advised in the following situations:
  • rapidly worsening coagulopathy
  • major haemorrhage
  • reversal of warfarin
  • specific clotting factor deficiencies

Amount

10-15 ml/kg over 30 minutes

If child weighs over 20kg, can round to nearest unit (approx. 250ml)

Cryoprecipitate

Indications

• Correction of a low fibrinogen level due to:
  • DIC / severe sepsis
  • severe liver disease
  • major haemorrhage
  • congenital hypofibrinogenemia / afibrinogenemia (if fibrinogen concentrate unavailable)
• Usually given to correct a low fibrinogen if a child is bleeding or requires a surgical procedure.
• Occasionally warranted to correct a very low (or rapidly falling) fibrinogen in the absence of bleeding/surgery, e.g. new presentation of leukemia (especially AML).
• Correction of fibrinogen with cryoprecipitate in other situations is rarely needed.
• Occasionally used as a rich source of factor VIII and von Willebrand factor (if specific factor concentrates not available).

Amount

Initially 5 ml/kg over 30 minutes

Young children may require 10 ml/kg.

References

• Buchanan GR (2005) Blood transfusions in children with cancer and hematologic disorders: why, when, and how? Pediatr Blood Cancer 44:114–116
• Wong EC, Perez-Albuerne E, Moscow JA, Luban NL (2005) Transfusion management strategies: a survey of practicing pediatric hematology/oncology specialists. Pediatr Blood Cancer 44:119–127
• Agrawal AK, Hastings CH, Feusner J (2011) Hematologic supportive care in children with cancer. In: Pizzo PA, Poplack DG (eds) Principles and practice of pediatric oncology, 6th edn. Lippincott Williams and Wilkins, Philadelphia
• Guyatt G, Gutterman D, Baumann MH et al (2006) Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest 129:174–181
• Wong, E.C.C. (Ed.), 2015. Pediatric Transfusion Medicine Handbook. fourth ed. AABB Press, Bethesda, MD (Co-edited with Drs. Roseff, Sloan, Punzalan, Sesok-Pizzini, Josephson, Strauss, and King).
• Book chapter edited by Dr Keith Sibson, Consultant Hematologist, GOSH. Paediatric Haematology & Oncology: Supportive Care Protocols. 5th edition version 1.0 (2023).

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