Component |
Description |
Indication |
Type of Filter |
Dose |
Rate |
Administration |
Special Considerations |
Whole blood |
Single-donor anticoagulated blood |
Massive blood loss Exchange transfusion Special procedures (ECMO or CRRT to prime the circuit, apheresis) |
170 micron filter |
Massive blood loss—20 mL/kg initially
Exchange transfusion: two times child’s blood volume |
As rapidly as necessary to reestablish blood volume
45-60 minutes (longer if he-modynamically unstable) |
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Always administer ABO group and Rh-type specific
In an emergency administer O-negative uncrossmatched blood. |
Packed red blood cells |
Concentrated red blood cells with most plasma, leukocytes, and platelets removed |
Severe anemia
Surgical blood loss Suppression of erythropoiesis (e.g., thalassemia or sickle cell anemia)
ECMO—blood loss from bleeding or multiple sampling for laboratory analysis |
170 micron filter |
5 mL/kg/hour |
10 mL/kg |
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Administer ABO group and Rh-type specific if possible. If not, group and type compatible can be transfused safely. May use O-negative uncrossmatched blood for infants up to 4 months of age
Red blood compatibility: |
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Recipient |
Donor |
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A
B
AB
O
Rh+
Rh−
Undetermined |
A, O
B, O
AB, A, B, O
O
Rh+
Rh−
O |
Saline-washed red blood cells |
Red blood cells washed with normal saline, which removes 80% leukocytes |
Children with history of repeated febrile transfusion reactions
Immunocompromised patients |
Same as packed red blood cells |
Same as packed red blood cells |
Same as packed red blood cells |
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Same as packed red blood cells |
Frozen deglycerolized red blood cells |
Specially processed red blood cells that can be stored for up to 3 years |
Rare blood types History of repeated febrile nonhemolytic reactions not responsive to other leukocyte depletion methods
Immunoglobulin A (IgA) deficiency with sensitivity to IgA |
Same as packed red blood cells |
Same as packed red blood cells |
Same as packed red blood cells |
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Same as packed red blood cells |
Albumin |
A plasma protein available in 5% and 25% solutions |
5% Solution: hypoproteinemia, volume deficits
25% Solution: severe burns, cerebral edema |
Not all plasma protein require a filter, if filter is required, use the filter that comes with the product |
5%: Hypoalbuminemia or hypovolemia 10 mL/kg per dose
25%: 1 g/kg = 4 mL/kg |
5%: 1-2 mL/minute (60-120 mL/hour can be administered as fast as possible to correct shock)
25%: 0.2-0.4 mL/minute (12-24 mL/hour) |
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Needs no blood filter
Only one person must identify product and patient
Vital signs can be taken prn
Compatibility testing not required
25% Albumin rapidly mobilizes large volumes of fluid into circulation (therefore, watch for pulmonary edema or other symptoms of fluid overload)
Product is stored at room temperature and has very long shelf life
Check expiration date before administering |
Fresh frozen plasma |
Contains all the clotting factors and some fibrinogen |
Massive hemorrhage Hypovolemic shock Multiple clotting deficiencies |
170 micron filter |
10-30 mL/kg |
Hemorrhage—as indicated by patient’s condition Clotting deficiency—over 2-3 hours |
Administer within 6 hours of thawing to preserve clotting factor activity |
Donor’s plasma should be ABO compatible with recipient’s red blood cells.
Rh compatibility not required because product does not contain red blood cells. |
Platelets |
Platelets suspended in a small amount of plasma |
Severe thrombocytopenia (platelet count <20,000)
Platelet count <50,000 in child who requires surgery or in child with hemorrhage or imminent bleeding
Cardiac surgery with massive blood replacement
Platelet count <80,000-100,000 in child undergoing ECMO or CRRT |
170 micron filter |
10 mL/kg or 1 random unit per year of age |
Platelets may be given by IVP (5-10 minutes/U) if volume is a problem, transfuse total dose over 2-3 hours using infusion pump. |
Gently agitate bag even more often (every hour) than other blood products because platelets tend to clump; if giving pooled random platelets or platelet aliquots, notify the blood bank 60 minutes before anticipated transfusion time to allow for special handling. |
Must be Rh compatible; ABO plasma compatibility preferred
Available platelets include
• Random—different donors, not necessarily type specific
• Type specific—blood type is the same as recipient
• Single donor—pheresed platelets from single donor (1 pheresed platelet unit is equivalent to 8-10 random platelets)
• HLA-pheresed—HLA testing has been done and matched to the recipient’s HLA type. |
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Platelets may be irradiated to inactivate donor lymphocytes that cause graft versus host disease in immunocompromised patients.
Premedicate as ordered, if patient has a history of reaction.
If single-donor or HLA platelets are ordered, obtain a 1-hour and a 24-hour platelet count after transfusion to determine adequate platelet response.
Observe patient for transfusion reaction because platelets may be contaminated with some red blood cells. |
Cryoprecipitate |
A concentration of clotting factors VIII, XIII, fibrinogen and von Willebrand factor |
Hemophilia A von Willebrand disease
Hypofibrinogenemia
Disseminated intravascular coagulation (DIC) |
170 micron filter |
One bag per 5 kg, for mild bleed
One bag per 2 kg, for severe life-threatening bleed
Repeat every 12-24 hours as necessary |
May infuse as quickly as possible or be given by IVP
Each bag contains about 15 mL |
Neonates: Use syringe to draw cryo through filter.
Infuse through syringe pump.
Administer within 6 hours of thawing. |
Monitor vital signs as instructed
Administer ABO compatible Rh type (compatibility preferable, but not required). |
Granulocytes |
Infection-fighting white blood cells |
Severe gram-negative infection or severe neutropenia unresponsive to routine forms of therapy in immunosuppressed patient
Severe granulocyte dysfunction |
170 micron filter |
10-15 mL/kg per dose |
About 5 mL/kg/hour |
Granulocyte product must be irradiated (if so ordered) and infused within 24 hours of donation, preferably within 6 hours of donation. |
Type and crossmatch needed before transfusion
Mild fever and chills are a common reaction.
Compress blood bag to mix the white cells periodically throughout the transfusion.
Vital signs should be taken every 15 minutes × 4, then every hour during infusion.
Amphotericin cannot be administered for 6 hours before or after granulocyte transfusion. |
Factor VIII concentrate |
Sterile lyophilized powder containing the blood coagulation factor VIII, which is prepared from pooled human plasma |
Hemophilia A |
Filter needle provided with product |
Minor bleed: 20 U/kg Severe bleed: 40 U/kg |
Administer by IVP over about 5 minutes (2 mL/minute max). If patient complains of headache, slow the rate because product is high in protein. |
Reconstitute product per manufacturer instructions. Withdraw solution from vial using filter needle, then administer through syringe.
Administer within 1 hour of reconstitution. |
Dose is ordered in units.
No compatibility testing is required.
Children on long-term therapy, if other than type O, should be monitored for hemolysis caused by isoagglutinins (anti-A and anti-B antibodies).
Group-specific concentrates are available if needed. |
Factor IX complex |
Concentrated powdered blood coagulation factors II, VII, IX, and X |
Congenital factor deficiency VII and X; acquired deficiency of factors II, VII, IX, and X |
Filter needle provided with product |
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Administer by IVP over about 5 minutes.
Maximum rates: Monoclate = 2 mL/minute Humanate = 4 mL/minute Others = 10 mL/minute |
Reconstitute product per manufacturer instructions. Withdraw solution from vial using filter needle, then administer through syringe. |
No type or crossmatch required |
