Massive transfusion (peds)

This page is for pediatric patients; for adult patients see massive transfusion

Overview

Blood product unit conversions

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
  • 25 mL/kg PRBC
  • 20 mL/kg FFP
  • call for platelets for pack 2
Children 10-20 kg
  • 1u PRBC
  • 1u FFP (thaw immediately after PRBC issued)
  • call for platelets for pack 2
Children 20-49 kg
  • 2u PRBC
  • 2u FFP
  • call for platelets for pack 2
Children > 50 kg
  • 4u PRBC
  • 4u FFP
  • call for platelets for pack 2

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

See Also

External Links

References

Authors:

Ross Donaldson