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Oncology - care of the oncology patient admitted to PICU - blood testing and blood product transfusion

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  • Patients should receive irradiated and leukocyte depleted blood products
  • Patients post stem cell/bone marrow transplant should receive irradiated, leukocyte depleted and CMV tested negative blood products (unless the patient is known CMV +ve).
  • Post chemotherapy patients will generally become cytopenic day 8 to 14.

Transfusion Parameters

Need to take into account patient age and clinical state.

General guidelines are:

  • transfuse if haemaglobin below 80g/L or patient symptomatic
  • transfuse platelets if less than 10 x 109 or symptomatic, or febrile
  • post BMT platelets transfuse less than 20 x 109 or symptomatic
  • pre procedure or patient bleeding transfuse to get platelet count above 50 x 109/L
  • Pre LP/BMA transfuse to platelets 100 x 109
  • FFP/Cryo/albumin 20%/IVIG transfuse as per PICU guidelines

Blood Tests

  • as per PICU protocol
  • newly diagnosed or relapsed pts - please see tumour lysis protocol
  • if pt on G-CSF (Filgrastim) ensure FBC with differential done daily

Post Stem Cell or Bone Marrow Transplant

  • daily CBC, urea and creatinine
  • twice weekly coagulation tests
  • twice weekly CMV(tuesday and thursday)
  • monthly EBV, MRSA and VRE screen
  • If patient on mycofenalate, tacrolimus or cyclosporine do levels and proceed to give dose. Subsequent doses will be changed if necessary.
    • mycofenalate, tacrolimus and cyclosporin levels weekly

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Document Control

  • Date last published: 10 June 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Owner: Fiona Miles
  • Editor: John Beca
  • Review frequency: 2 years