Does not apply to neonatal transfusions, which for the purpose of transfusion medicine, is an infant under 4 months of age.

The most commonly transfused pediatric patients are those in PICU, those undergoing cardiac surgery, transfusion-dependent children with inherited conditions, and those following intensive chemotherapy.

Red Blood Cells

• The two major indications for RBC transfusions are prevention or alleviation of symptoms, and signs of inadequate oxygen delivery.
• When deciding to transfuse a critically ill pediatric patient, the overall clinical context must be taken into account.
• As in adults, critically ill children benefit from a restrictive transfusion strategy (70 g/L).
• RBC transfusion is often recommended in critically ill children or those at risk for critical illness when the hemoglobin concentration is <50 g/L. Transfusion is not recommended in hemodynamically stable patients with a hemoglobin concentration 70 g/L.
• Clinical judgment is required for hemoglobin between 50 – 70 g/L.
• RBC transfusions are dosed at 10ml/kg.
• In hemorrhagic shock, RBCs, plasma, and platelets should be transfused in a ratio of 2:1:1 or 1:1:1.
• Acute brain injuries, consider RBC transfusion if hemoglobin is 70-100 g/L.
• Oncologic diagnoses, or those undergoing hematopoietic stem cell transplant, consider RBC transfusion if hemoglobin 70-80 g/L.
• Uncorrected congenital heart disease, maintain hemoglobin of 70-90 g/L depending on cardiac reserve.

Platelets and Plasma

• In general, guidelines for adult patients are applied to children due to the lack of high-grade evidence.
• Platelet transfusions are indicated to prevent or decrease bleeding in the context of quantitative or qualitative platelet disorders.
  • Dose platelets are typically 5 to 10 mL/kg.
• The main indication for plasma transfusion is the correction of bleeding from multiple acquired coagulation factor deficiencies.

Normal hemoglobin values (Lau, 2017).

Created by Ella Barrett-Chan, MSI UBC 2023

Indications for transfusion of red blood cells (Lau, 2017).

Indications for transfusion of plasma (Lau, 2017)

1. Neonatal and pediatric transfusion. Professional Education. Chapter 13
   Lau, W. (2017, August 2).
   Canadian Blood Services
   

   
   

2. Fresh Frozen Plasma for Neonates and Infants, Leucocyte Depleted
   Ltd.  (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee.
   – JPAC

   
   

3. Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
   Valentine, S. L., Bembea, M. M., Muszynski, J. A., et. al.  19(9), 884–898.
   – Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (2018). Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.