Massive transfusion (peds)
This page is for pediatric patients; for adult patients see Massive transfusion
Overview
Blood product unit conversions
- PRBC: 1 bag = 1 unit = 350 mL
- FFP: 1 bag = 1 unit = 250 mL
- Platelets: 1 bag = 1 pack = 5 units = 250 mL
- Cryoprecipitate: 1 bag = 5 units = 200 mL
Indications
- Requiring > 40 mL/kg (40% blood volume) or 4 u for adult / patient > 30 kg over 2 hours or less
- Requiring or likely to require complete blood volume replacement or 10 u for adult in 24 hours
Age-specific blood volume
- Newborn – 1 month 90 mL/kg
- 1-12 months 85 mL/kg
- 1-14 years 80 mL/kg
- > 14 years 75 mL/kg
- Obese children 65 mL/kg
Contraindications
Equipment Needed
Recommended lab studies
- Initial: Type & Cross, CBC (Hgb, plt), PT/PTT, Fibrinogen, ionized Ca, K+ (basic metab panel), pH
- After first 80 mL/kg PRBC: repeat above + FDPs
- After every 40 mL/kg PRBC from then on: repeat above + FDPs, lactate
Procedure
Pediatric Massive Transfusion Protocol[1][2]
MTP Pack 1 | MTP Pack 2 | MTP Pack 3 | MTP Pack 4 | MTP Pack 5 |
Children < 10 kg | ||||
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Children 10-20 kg | ||||
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Children 20-49 kg | ||||
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Children > 50 kg | ||||
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Complications
- Coagulopathy
- Hypothermia
- Hyperkalemia
- Hypocalcemia
- Transfusion reaction
- Transfusion-related acute lung injury
- Fluid overload