Blood Component Support in Paediatric and Adolescent Oncology and Haematology

Publication: 01/12/2011  --
Last review: 04/09/2019  
Next review: 04/09/2022  
Clinical Guideline
CURRENT 
ID: 2879 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2019  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Guideline for blood component support in paediatric and adolescent oncology and haematology

  1. Introduction
  2. Guideline Statement
  3. Guideline Effect
  4. Equality and Diversity Statement
  5. Consultation Process
  6. Documentation Control Section

Appendices

  1. Abbreviated Hints for Blood Component Transfusion

1. Introduction

Indication for transfusion of blood components

As with any action undertaken in healthcare, the transfusion of blood components must be proposed in the belief that the benefits of the action outweigh the disadvantages.

Avoidance of unnecessary transfusions is the SAFEST policy. Transfuse because the patient will, most likely, receive a benefit from the components proposed.

All blood components must be checked against the patient at the bedside. This is the final opportunity to prevent transfusion of the wrong component.

The indication for any transfusion should be documented in the medical notes and all transfusions must be prescribed by a doctor (see SHOT Report – Serious Hazards of Transfusion - www.shot-uk.org).

All components are now LEUCODEPLETED (but CMV seronegative and irradiated components must be specifically requested and prescribed - See section III).

Rates of transfusion depend upon the clinical scenario but in a non-urgent situation the following are a guideline:
Red cells Volume as calculated below, given over 5ml/kg/hr (usual max rate 150ml/hour) - often practically works out at 4 hours
Platelets 30 mins
FFP 30 mins/unit

Back to top

2. Guideline

I. Standard Components

A. Red Cells

The following formula is used to calculate the volume of blood required for a packed red cell transfusion

Desired Hb (g/L) - actual Hb (g/L) x weight (kg) x 5
10

NOTE: The ‘transfusion factor’ has been calculated on the basis of actual pre/post values obtained in haematology/oncology patients. This is in keeping with values obtained from previous case reviews in PICU patients and the haematocrit of red cell donations. This varies from the generic ‘4’ of the BCSH guideline.

Where possible, the calculated volume may be altered +/- 15% to transfuse with whole units of blood (bags are approximately 280 - 320mls).

Also note that transfusions should usually be ‘capped’ at 2 units of blood (~600ml maximum). Requirements apparently beyond this should be discussed with a Consultant.

  1. Patients with malignancies (anaemia secondary to chemotherapy)
    Transfuse if symptomatic of anaemia, or consider if Hb is 70g/l or below
    to a desired post-transfusion Hb of 100 g/l
    If Hb is 70g/l – 80g/l and the patient is being discharged, rather than transfusing, consider whether the Hb may be resolving (e.g. going into the 3rd week post chemotherapy)

    This group of patients very rarely require more than two units of blood (except on haematologist advice).

  2. Thalassaemia
    Children with thalassaemia major are usually on a monthly transfusion programme, their desired post-transfusion Hb is 150g/l: see specific guideline on Leeds Health Pathways.
    (maintain a pre-transfusion Hb of 100g/l).

  3. Severe aplastic anaemia
    These children are transfused at the discretion of their consultant; the desired post-transfusion Hb is 100g/l.

  4. Sickle cell disease
    Acute transfusion of sickle cell patients is reserved for exceptional cases not responding to conservative management. Discussion with a consultant haematologist is needed before transfusion of blood to these cases.
    Some patients are on a chronic transfusion programme to minimise HbS% - see specific sickle cell management guidelines on Leeds Health Pathways.

  5. Patients undergoing radiotherapy
    These children should have Hb of at least 100 g/l, transfuse to 120 g/l.

  6. Other indications (e.g. major trauma)
    Transfusion for indications outside the ‘normal’ situations above require specific responses. Seek specialised advice (e.g. massive transfusion guidance).

B. Platelets

Neonates should receive 10-20 ml/kg
Infants <1 year should receive 1-2 units
Children >1 year should receive 1 “adult therapeutic dose” – (as single-donor apheresis unit).

Indications

  1. Patients with malignancy or post-transplant or severe aplastic anaemia.

    Mucosal nose/gum bleeding that will not stop (with normal clotting).

    or Platelets <10 x 109/l (asymptomatic/no clinical signs of bleeding)
    or Platelets <20 x 109/l if brain tumour
    GI Bleeding may require platelet transfusions if <75 x 109/l

    Platelets <25 x 109/l in patients undergoing Radiotherapy need discussion with clinical oncology team as complex and patient/protocol specific.

  2. Lumbar Puncture and Bone Marrow

    This will vary depending on the patient’s circumstances. Please discuss with the Haematology Registrar or Consultant who is doing the procedure if the count is <50 x 109/l as the patient may require a transfusion beforehand.

  3. Surgery

    Platelets >50 x 109/l should be sufficient for a line insertion or biopsy. Patients having Vascath insertion for stem cell harvest require platelet count >50 x 109/l. Please discuss with consultant if unsure.

    Contraindications

    Platelets are not routinely used in Immune Thrombocytopenic Purpura (ITP) unless there is severe bleeding. Please discuss with a Consultant before use. Platelet transfusion in cases of Thrombotic Thrombocytopenic Purpura could lead to a fatal exacerbation so should be avoided, speak to a Consultant if in doubt.

  4. Naso-gastric tube

    Prior to inserting naso-gastric tube there is no need to check FBC. If insertion is traumatic and epistaxis does not cease within 10 minutes of applied pressure/ cold pack, or if bleed is profuse then check platelet count and administer platelets if <50 x 109/l.

Specific patients or situations may require deviations from this guidance: see the palliative care guidance in particular for patients towards the end of life.

C. Fresh Frozen Plasma

NB
FFP has the highest rate of serious adverse reactions (allergy, immune haemolysis, transfusion-related acute lung injury) of any blood component and must always be used for a firm clinical indication. If in doubt – discuss.

As a vCJD risk-reduction measure, all neonates and children born after Jan 1st 1996 MUST only be transfused with methylene blue treated fresh frozen plasma (MB-FFP)) sourced from non-UK donors or solvent-detergent treated pooled FFP. The transfusion laboratory in LTHT is now issuing solvent-detergent treated pooled FFP (Octaplas) for all indications for children aged >1 year of age. Neonates and infants continue to be supplied with MB-FFP.

Indications for use (dose 10-20 ml/kg)

  1. 1. In the face of bleeding and disturbed clotting FFP may be indicated, please discuss with Haematologist or Consultant on call. Vitamin K may also be indicated.
  2. Factor deficiency with no factor concentrate e.g. factor V deficiency. Please discuss with Haematologist or Consultant on call.

    TTP – FFP is usually given in conjunction with plasma exchange however may be given alone if urgently required out of hours and there is delay to institution of plasma exchange. Urgent plasma exchange must however be arranged immediately in parallel.
  3. Plasma exchange – the dose of FFP will depend upon the number of litres exchanged. . (NB for large volume plasma exchange, the DH now recommends the use of solvent-detergent treated pooled FFP (Octaplas) in the treatment of TTP. It is virucidally inactivated, made from low vCJD-risk donors and is depleted of high MW vW multimers. Arranged via Blood Bank after discussion with Consultant Haematologist).

FFP is no longer indicated for reversal of Warfarin effect, Prothrombin Complex Concentrate (PCC) 25 - 50 iu/kg is now used for patients with major bleeding. For minor bleeding or no bleeding and INR>6 use vitamin K. Please review the relevant anti-thrombotic treatment in children guideline and discuss with haematologist.

N.B. FFP is not effective in reversing the effect of heparin.

D. Cryoprecipitate

Dose 10-15 ml/kg

This may be indicated in the context of deranged coagulation and bleeding, especially if there is DIC. However we would recommend that FFP is given first and a coagulation screen with D-Dimers and Fibrinogen is repeated. If the fibrinogen remains below 1.0 g/dl then treatment with Cryoprecipitate may be indicated. Please discuss with Haematologist or Consultant on call. If cryoprecipitate is not effective consider the use of fibrinogen concentrate available from the Transfusion laboratory but discuss with the consultant on call before its use.

E. Clotting Concentrates

All patients with congenital bleeding disorders should be discussed with a haematologist or the consultant on call as use of factor concentrates and blood products should be avoided if an alternative treatment such as local pressure, tranexamic acid or desmopressin is available. Patients with haemophilia A may require factor VIII and patients with haemophilia B may require factor IX when admitted. Patients with rarer coagulation disorders may require other specific concentrates. These are given as an intravenous bolus. Details of individual treatment are documented in the front sheet of the notes or on PPM+. See also specific guideline on Leeds Health Pathways.

Specific hospitals may have different models of care for patients with clotting disorders.

F. Other Modalities of Therapy

If bleeding occurs consider a local cause and local remedy (i.e. cautery for epistaxis or surgery if indicated).

Other pharmacological interventions include
Vitamin K
Tranexamic acid (avoid in cases of macroscopic or heavy microscopic haematuria)
Desmopressin
NovoSeven (recombinant factor VIIa) (always discuss with a haematologist)

II. IRRADIATED AND CMV NEGATIVE COMPONENTS

Irradiated blood components

Cellular blood components can be irradiated to inactivate lymphocytes that could cause graft-versus-host disease. Irradiation can increase RBC fragility and lower shelf life.

TA-GvHD (Transfusion Associated Graft versus Host Disease) is a very rare but usually fatal complication following transfusion of lymphocyte containing blood components (red cells, platelets and granulocytes).

The risk associated with an individual transfusion depends on the number and viability of contaminating T-lymphocytes, susceptibility of the recipient’s immune system to their engraftment and degree of immunological (HLA) disparity between donor and patient.

TA-GvHD has been reported in children with severe primary T lymphocyte immunodeficiencies characterized by an absence of T lymphocytes or a severe defect of T cell function.

In the newborn infant the presenting features of immunodeficiency syndromes may be unrelated to the immune defect (e.g. cardiac disease, hypocalcaemia, thrombocytopenia, eczema) and a high index of suspicion is required, particularly in infants less than 6 months old with recurrent or persistent respiratory or gastro-intestinal infections.

In older patients, a severe T lymphocyte deficiency can be induced by certain acquired conditions (e.g. Hodgkin’s disease) or certain immunosuppressive or cytotoxic treatments.

All severe T lymphocyte immunodeficiency syndromes should be considered as indications for irradiation of cellular blood components. Once a diagnosis of immunodeficiency has been suspected, irradiated components should be given while further diagnostic tests are being undertaken.

Within Leeds Hospitals Trust, a guideline is available: detail.aspx?ID=3157

CMV Negative blood components

The risk of transmission in multiply-transfused CMV negative recipients is greatly reduced by the provision of leucodepleted blood components and this is therefore viewed by the Department of Health (2012) as sufficient to prevent CMV transmission in the majority of patients.

DH / SaBTO have reviewed the evidence around the replacement of CMV seronegative cellular blood components (both red cells and platelets) with leucodepleted blood components. The following conclusions were reached:

  1. CMV seronegative red cell and platelet components should be provided for intra-uterine transfusions and for neonates (i.e. up to 28 days post expected date of delivery), and therefore all small sized blood packs and other cellular blood components intended for neonates should be provided as CMV seronegative (however, for ease, LTHT blood bank will continue to provide CMV negative blood components up to 6 months post-delivery).
  2. Granulocyte components should continue to be provided as CMV seronegative for CMV seronegative patients.
  3. CMV seronegative blood components should be provided where possible for pregnant girls regardless of their CMV serostatus, who require repeat elective transfusions during the course of pregnancy (not labour and delivery). This mainly applies to patients with haemoglobinopathies who are managed in specialist centres. However CMV seronegative blood components are not expected to be generally available in all hospitals and therefore for emergency transfusions in pregnant women, leucodepleted components are recommended.
  4. All blood components (other than granulocytes) in the UK now undergo leucodepletion, which provides a significant degree of CMV risk reduction. This measure is considered adequate risk reduction for all other patients requiring transfusion (haemopoetic stem cell transplant patients, organ transplant patients, and immune deficient patients, including those with HIV) without the requirement for CMV seronegative components in addition.
  5. CMV PCR monitoring should be considered for all haemopoeitic stem cell and solid organ transplant patients (even CMV negative donor/negative recipients) to allow early detection of any possible CMV infection (whether transfusion-transmitted or primary acquired infection).

Indications:

Patient Group / Condition/Treatment

Special blood requirement

Further information / Length of time to receive special blood requirements

Haematology Patients:

   

Aplastic Anaemia

  • patients likely to receive PBSCT and/or treated with immunosuppressive therapy (ATG, ALG, alemtuzumab)

Irradiated

Irradiated blood components for life *

Hodgkin’s Disease (Hodgkin’s Lymphoma)

Irradiated

Irradiated blood components for life

Patients who have unclassified T cell immunodeficiency

Irradiated

Irradiated blood components for life

Patients who have received Purine Analogue Drugs

  • Fludarabine
  • Cladribine
  • Deoxycoformicin
  • Chlorodeoxyadenosin
  • Nelarabine

Irradiated

Irradiated blood components for life

Patients who have received Purine Antagonist Drugs

  • Bendamustine
  • Clofarabine

Irradiated

Irradiated blood components for life *

Patient undergoing BM or PBSC harvest

Irradiated

Irradiated blood components from 14 days prior to & during stem cell harvesting.

Irradiated blood components from 14 days prior to pre-conditioning chemo for all allograft BMT/PBSCT

Patients proceeding to autograft will remain on irradiated blood components for life *

Post Allo BMT/PBSCT

Irradiated

Irradiated blood components for life *

Post Auto PBSCT

Irradiated

Irradiated blood components for life *

Patients receiving HLA matched components

Irradiated

Only the HLA matched components need to be irradiated

Patient who have received immunosuppressive antibody treatments

  • anti-thymocyte globulin (ATG)
  • anti-lymphocyte globulin (ALG)
  • alemtuzumab / Campath (anti-CD52)
  • Muromonab (OKT3)

Irradiated

Irradiated blood components for life

Patients receiving granulocytes

Irradiated
CMV Neg (for all CMV Neg patients)

Once irradiated, transfuse with minimum delay
In patients receiving granulocytes only, it is only the granulocytes that need to be irradiated/CMV Neg

Bone marrow/stem cell donors

Irradiated

Irradiated red cells/platelets for 14 days prior to and/or during bone marrow/stem cell harvest

Renal Patients:

   

Patient who have received immunosuppressive antibody treatments

  • alemtuzumab (anti-CD52)/Campath
  • Muromonab (OKT3)

Irradiated

Irradiated blood components for life

Renal Transplant
(if in receipt of Campath / Muromonab or, transplanted after 1/4/2011)

Irradiated

Irradiated blood components for life

Live renal organ donors

Irradiated

For 7 days prior to and during organ transplantation

Obstetric Patients:

   

Pregnancy

CMV Neg

All women receiving elective antenatal transfusion should receive
CMV negative blood components - not necessary during labour or post natal.

Intra-Uterine Transfusion (IUT)

Irradiated
CMV Neg
Group O Neg

Platelets transfused in-utero to treat allo-immune thrombocytopenia

Red cells will be less than 5 days old with a Hct no greater than 0.75

Transfuse irradiated blood components within 24 hours of irradiation

Baby must receive irradiated blood components for 1 year post expected date of delivery*

Baby must receive CMV negative blood components until 6 months old *

Neonates: All children <6months to receive CMV negative blood components

Exchange Transfusion (Neonatal)

Irradiated
CMV Neg
Group O Neg

Red cells will be less than 5 days old

Transfuse irradiated blood components within 24 hours of irradiation

Must have irradiated if previous IUT; otherwise irradiated if time allows

Post Intra-Uterine Transfusion

Irradiated
CMV negative

Babies post IUT must receive irradiated blood components for 1 year after expected date of delivery*

Baby must receive CMV negative blood components until 1 year old

Paediatrics: All children <6months to receive CMV negative blood components

Di George syndrome (3rd and 4th arch/pouch syndrome)

Irradiated

Irradiated blood components for life

SCID – Severe Combined Immunodeficiency

Irradiated

Irradiated blood components for life

Wiskott Aldrich Syndrome

Irradiated

Irradiated blood components for life

Purine nucleoside phosphorylase deficiency (PNP)

Irradiated

Irradiated blood components for life

Leiner’s disease (Leiner-Moussous disease, Erythrodermia desquamativa Leiner)

Irradiated

Irradiated blood components for life

Reticular dysgenesis (aleukocytosis)

Irradiated

Irradiated blood components for life

Adenosine deaminase deficiency

Irradiated

Irradiated blood components for life

MHC class I or class II deficiency (Bare Lymphocyte Syndrome)

Irradiated

Irradiated blood components for life

Leucocyte adhesion deficiency

Irradiated

Irradiated blood components for life

Omenn’s syndrome

Irradiated

Irradiated blood components for life

Ataxia telangiectasia (Louis–Bar syndrome, Boder-Sedgwick syndrome)

Irradiated

Irradiated blood components for life

Cell-Mediated Immunodeficiency

Irradiated

Irradiated blood components for life

General:

   

Patient who have received immunosuppressive antibody treatments

  • anti-thymocyte globulin (ATG)
  • anti-lymphocyte globulin (ALG)
  • alemtuzumab (anti-CD52)
  • Muromonab (OKT3)

Irradiated

Irradiated blood components for life

Patients receiving components from a first or second degree relative

Irradiated

Only the components from the relative need to be irradiated

Patients receiving umbilical cord blood transplant under trial conditions

Irradiated
CMV Neg

Irradiated blood components for life
CMV negative blood components for the duration of the cord blood transplant trial and then follow local policy

Key: * for ease and to prevent confusion, this time limit recommendation (which does not follow national recommendations) has been lengthened for to ensure patient safety

There are continually new drugs being introduced that may result in the need for irradiated blood components, please check with Blood Bank for the most up to date requirements.
NB: there is no need to routinely irradiate blood components for patients with HIV
NB: there is no need to provide CMV negative blood components for patients with HIV and/or organ transplant patients

III. PLATELET REFRACTORINESS

Some patients may not achieve good increments after platelet transfusions; this should be suspected clinically by failure to ameliorate bleeding/bruising symptoms. It is defined by failure to increment the platelet count after transfusion. Practically, this is suggested by an increment of <20 x 109/l 1 hour post-transfusion or <10 x 109/l 24 hours post-transfusion, confirmed on 2 consecutive transfusion episodes.

The most common causes are non-immune (sepsis, bleeding, DIC, antibiotic or antifungal therapy) rather than immune (anti-HLA or antiplatelet antibodies). If a patient fails to achieve an increment on more than two occasions then non-immune causes should be considered and treated if possible. Blood should be sent to the tissue typing laboratory at the National Blood Service at Sheffield (NOT the local hospital) to look for antibodies. This must be discussed with them first and the transfer of samples arranged through the LGI Blood Bank. If a report confirms a relevant antibody then the patient will require HLA matched platelets – please discuss with Haematology Registrar or Consultant. It is essential that the local Blood Bank is kept in the picture as any matched platelets will be issued through the laboratory. When transfusing HLA matched platelets a 1 hour increment must be performed to check whether the platelets are effective. Failure to do so may result in no further HLA matched platelets being issued as the team at the NBS would be unable to assess the efficacy of the platelets already issued leaving them unable to provide suitable platelets.

Rarely platelet specific antibodies may be encountered – please discuss with Haematologist. Expert transfusion medicine advice is available 24/7 through the Blood Service.

IV. TRANSFUSION REACTIONS

Transfusion reactions (other than mild febrile and urticarial reactions) must be reported to the Blood Bank as they will need to be investigated by the Hospital Transfusion Team (HTT) and may be discussed at the Hospital Transfusion Committee and, if indicated, be reported to SHOT and SABRE. Severe and rare reactions should also be reported to a Haematologist for advice on management.

Severe Reactions

(Defined as: a rise in temperature >2ºC above patient baseline +/- life threatening symptoms)

If a severe reaction is suspected the transfusion must be stopped immediately and the unit, together with the attached infusion set, returned to Blood Bank along with appropriate blood samples from the patient (discuss with laboratory). Further management should be discussed with a Haematologist. NB in the case of serious reactions, ALWAYS check that the identity details on the blood bag label correspond with those on the patient’s wristband. Remember, if your patient is getting the wrong blood, another patient may be receiving the other bag inappropriately!

Acute Haemolytic Transfusion Reaction – suspect if patient feels back pain, shivery, feverish, or there is hypotension, haemoglobinuria, oliguria or evidence of DIC, often within the first few ml of transfusion. This is usually due to the transfusion of ABO incompatible blood and has a high mortality rate.

Bacterial contamination of blood component – all blood components should be inspected before administration. If there is any evidence of contamination (unexpected cloudiness, odd colour or haemolysis) then the component must be returned to blood bank immediately (administration of infected components is often fatal). This should be suspected if the patient becomes febrile (>39°C or greater than 2°C higher than the baseline) and hypotensive soon after commencing the transfusion, usually within transfusion of 100 ml). The symptoms and signs of bacterial sepsis and acute haemolysis can, initially, be indistinguishable and both diagnoses should always be considered if a patient becomes acutely ill soon after starting transfusion of a blood component.

Less Severe Reactions

(Defined as: a rise in temperature <2ºC above patient baseline

  1. Febrile Reaction (“non-haemolytic febrile transfusion reactions”)

    These are commonly seen towards the end of a transfusion or shortly afterwards. The patient develops a temperature and may complain of headache and/or shivering.

    If the temperature rise is less than 2ºC and the transfusion is still running, slow the transfusion and assess the patient carefully.

    If the patient is well and not neutropenic, give paracetamol and restart the transfusion at the original rate.

    If the patient is neutropenic but well, give paracetamol and complete the transfusion. Antibiotics should be started (after culturing the patient) if the criteria for febrile neutropenia are met (temperature >38°C, neutrophil count <0.5 ).

    If the patient becomes unwell or a severe reaction is suspected then the transfusion must be stopped immediately and the patient managed as for a severe transfusion reaction. Neutropenic patients should be cultured and started on antibiotics if not already on them.

  2. Urticarial or allergic reactions

    These are commonly caused by allergy to plasma proteins and therefore more commonly occur following transfusion of platelets or plasma components.

    These reactions do not necessarily recur with subsequent transfusions and a single episode does not require the routine prescription of “premedication”. Hydrocortisone and Chlorphenamine “cover” should be reserved for patients with recurrent reactions. IgA deficiency, with anti-IgA antibodies (very rare), should be excluded if there is recurrent severe urticaria or anaphylactoid reactions. Whenever blood components are transfused, there should be immediate access to a “crash trolley” containing adrenaline injection in case of anaphylactic reactions.

    Recurrent or severe events need to be discussed with the transfusion laboratory, use of platelets suspended in optimally additive solution may be required for future transfusions.

  3. Delayed Haemolytic Transfusion Reaction (DHTR)

    This should be suspected if there is a poorer than expected Hb response to transfusion or the patient becomes jaundiced a few days after transfusion. These are due to a secondary immune response of antibodies to antigens on the transfused red cells. The patient was “primed” by a previous transfusion, but the antibodies had become undetectable in the pre-transfusion antibody screen (most often seen with Kidd antibodies). The patient is typically jaundiced, may have a raised LDH, a positive Direct Antiglobulin (Coomb’s) Test and spherocytes on the blood film. DHTR occasionally cause significant renal dysfunction. If suspected, discuss with the Blood Bank and Haematologist to arrange further investigation and advice on management.

    Blood transfusion reactions should be treated as per the Trust Guideline for Safer Transfusion Procedures.

Rare but potentially severe reactions

The following reactions are rare but should be considered in sick patients. If suspected they must be discussed with a Haematologist.

  1. Transfusion-related acute lung injury (TRALI)

    This usually occurs within 6 hours of transfusion. It is especially associated with plasma-rich components but may occur after any transfusion). It is usually due to antibodies in the transfused plasma reacting against host leucocytes and sequestering in the lungs. Implicated donors are often females sensitised by pregnancies. Clinically the patients display an ARDS-like picture (non-cardiogenic pulmonary oedema) which may be misinterpreted as left ventricular failure due to fluid overload. A high percentage require ventilation. If the patient survives the acute phase there are not usually any long term sequelae. TRALI is probably the commonest cause of transfusion-related mortality in developed countries. The incidence is falling in the UK as most plasma is now sourced from male donors.

  2. Transfusion associated graft versus host disease (TA-GVHD)

    This was the commonest single cause of death associated with transfusion in the UK until 1997 (SHOT Reports). It is caused by donor T cells in the blood component reacting against an immunocompromised or HLA-haploidentical recipient. Clinically there is fever, rash, liver and renal failure and pancytopenia occurring 4-30 days post-transfusion. It is almost uniformly fatal. Prevention is by irradiation of blood components given to susceptible individuals (see earlier section on irradiated blood components). Universal leucodepletion has now made this a very rare complication (two cases reported to SHOT since 1997) but irradiation is still essential for complete protection.

Back to top

3. Guideline effect

All staff administering blood components must do so within local Trust and national policies with regard to blood transfusion. This Guideline is intended to assist staff in making decisions on the clinical management of children and young people receiving treatment under the care of the Paediatric and Adolescent Oncology and Haematology unit at Leeds Teaching Hospitals Trust.

Back to top

4. Equality and diversity statement

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups

Back to top

5. Consultation process

Consultation has taken place throughout the development of this Guideline with the following parties:

  • The Hospital Transfusion Team at Leeds Teaching Hospitals Trust
  • The Paediatric and Adolescent Oncology and Haematology Guideline review Group
  • The Paediatric and Adolescent Oncology and Haematology clinical Management Group at Leeds Teaching Hospitals Trust
  • The Humber and Yorkshire Coast and Yorkshire Cancer Networks’ Child and Adolescent Group

This document will be reviewed by the guideline development group in December 2022 or earlier if clinical evidence arises which necessitates a change.

Back to top

6. Document control

This document has been signed off by the Paediatric and Adolescent Oncology and Haematology Guideline review Group.

Back to top

Appendix A

RED CELLS

 

Trigger

Target

Malignant disease on chemotherapy

70g/L

100g/L

Undergoing Radiotherapy

100g/L

120 g/L

Thalassaemia Major

Routine

150 g/L

Sickle cell disease

ONLY ON CONSULTANT HAEMATOLOGIST ADVICE

Volume = (desired Hb – current Hb) x 0.5 x weight

Note that red cell transfusions should usually be ‘capped’ at 2 units of blood (~600ml maximum)

PLATELETS

Neonates

Infants <1 year

Children >1 year

10-20ml/kg

1-2 Paediatric Units

1 Adult Dose
(= 4 Paediatric Units)


No specific procedures

LP / Trephines

Other procedures

  • <10 x 109/l

unless

  • <20 x 109/l if brain tumour
  • <50 x 109/l & continuing bleeding or fresh petechiae

Discuss if

  • <50 x 109/l

Note: marrow aspirates less critical and usually do not require a specific platelet count

Line insertion
VasCath

  • <50 x 109/l

Provenance

Record: 2879
Objective:
Clinical condition:

Blood transfusion in children and young people with malignancy

Target patient group: Patients requiring blood component support in paediatric and adolescent oncology and haematology
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

The Hospital Transfusion Team at Leeds Teaching Hospitals Trust
The Paediatric and Adolescent Oncology and Haematology Guideline review Group
The Paediatric and Adolescent Oncology and Haematology clinical Management Group at Leeds Teaching Hospitals Trust
The Humber and Yorkshire Coast and Yorkshire Cancer Networks’ Child and Adolescent Group
BCSH Transfusion guidelines for neonates and older children

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 2.0

Related information

Not supplied

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.