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Blood Products - Red Blood Cells

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Transfusion Threshold

Patients undergoing marrow suppressive therapy should be transfused on the basis of symptoms rather than the Hb level.  Younger children can generally tolerate a lower Hb.  If a patient is nearing their known transfusion tolerance it may be helpful to transfuse them prior to discharge so they don't need to return a couple of days later.

There are situations when it is prudent to maintain Hb at a higher level:

  • ongoing bleeding
  • patient is experiencing symptoms from anaemia - this is particularly true of teenagers who may respond to a higher Hb threshold
  • neonates
  • patients receiving radiotherapy - keep Hb > 100 g/l.

There are also situations when transfusions should be limited where possible:

  • aplastic anaemia (sensitization to transfusions may decrease the chance of a successful transplant)
  • other bone marrow failure syndromes (e.g., Fanconi's, DBA) (as above)
  • chronic anaemia (e.g., hereditary spherocytosis)
  • a newly presenting patient with leukaemia and white cell count > 100 x 109/litre should not be transfused without discussion with the treating oncologist, even if mildly/moderately symptomatic from anaemia. Increased circulating red blood cells plus hyperleucocytosis increases risk of hyperviscosity.

Transfusion Volume

Order quantity by volume rather than units if possible:

Volume required = Required rise in Hb in g/l x weight (kg) x 0.4.

For example:

Hb 70 g/L aim is 100 g/L patient is 40 kg.

30 x 40 x 0.4 = 480 ml.

For patients of adult size this is 10-15 ml/kg for Hb of 80 g/L.

A RBC transfusion must be completed over a maximum of 4 hours. The usual rate is around 5 ml/kg/hr.

Diuretics are not routinely required. If there is fluid overload or a large volume transfusion then frusemide 0.5 - 1 mg/kg can be used.

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Document Control

  • Date last published: 20 April 2016
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network
  • Owner: Siobhan Cross
  • Review frequency: 2 years