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 Amounts[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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Example Instructions (Harbor-UCLA)
- Early involvement of trauma surgery attending or chief resident in decision
- Call Blood Bank and state that you are activating the MTP
- Send a type and cross BEFORE starting transfusions
- First MTP box ready within 10 min of phone call trigger: 6u PRBC, 4u thawed plasma (FFP)
- Second MTP box ready within 30 min of initial phone call trigger
- Successive boxes prepared and issued as needed q 30 minutes of prior box
- Consider platelets, cryoprecipitate (typically after 2nd box issued)
- Cryo takes 30 min to thaw and pool – plan ahead and request
- PRBCs type specific (preferred) or O negative or O positive for men, women > 55 years
- Plasma (FFP) is Group A – incompatible with 14% of pts (B or AB), could cause some hemolysis
- Return unused boxes to Blood Bank within 20 minutes if possible (so can return to inventory)
- MTP automatically terminated 8 hours after initiation, or if you begin to order quantities less than amount in MTP box
Complications
- Coagulopathy
- Hypothermia
- Hyperkalemia
- Hypocalcemia
- Transfusion reaction
- Transfusion-related acute lung injury
- Fluid overload