Massive transfusion (peds): Difference between revisions
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{{Peds top}} [[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<ref>http://pediatrictraumasociety.org/multimedia/files/clinical-resources/MTP-2.pdf</ref><ref>http://pediatrictraumasociety.org/multimedia/files/clinical-resources/MTP-3.pdf</ref>=== | |||
{| {{table}} | {| {{table}} | ||
| align="center" style="background:#f0f0f0;"|'''MTP Pack 1''' | | align="center" style="background:#f0f0f0;"|'''MTP Pack 1''' | ||
| Line 9: | Line 34: | ||
|- | |- | ||
| | | | ||
*25 mL/kg PRBC | *25 mL/kg [[PRBC]] | ||
*20 mL/kg FFP | *20 mL/kg [[FFP]] | ||
*call for platelets for pack 2 | *call for platelets for pack 2 | ||
|| | || | ||
*25 mL/kg PRBC | *25 mL/kg [[PRBC]] | ||
*20 mL/kg FFP | *20 mL/kg [[FFP]] | ||
*10 mL/kg platelets | *10 mL/kg [[platelets]] | ||
|| | || | ||
*25 mL/kg PRBC | *25 mL/kg [[PRBC]] | ||
*20 mL/kg FFP | *20 mL/kg [[FFP]] | ||
*10 mL/kg platelets | *10 mL/kg [[platelets]] | ||
*4 mL/kg | *4 mL/kg [[cryoprecipitate]] | ||
|| | || | ||
*25 mL/kg PRBC | *25 mL/kg [[PRBC]] | ||
*20 mL/kg FFP | *20 mL/kg [[FFP]] | ||
*10 mL/kg platelets | *10 mL/kg [[platelets]] | ||
*4 mL/kg | *4 mL/kg [[cryoprecipitate]] | ||
|| | || | ||
*25 mL/kg PRBC | *25 mL/kg [[PRBC]] | ||
*20 mL/kg FFP | *20 mL/kg [[FFP]] | ||
*10 mL/kg platelets | *10 mL/kg [[platelets]] | ||
*4 mL/kg | *4 mL/kg [[cryoprecipitate]] | ||
|- | |- | ||
| '''Children 10-20 kg'''|||||||| | | '''Children 10-20 kg'''|||||||| | ||
|- | |- | ||
| | | | ||
*1u PRBC | *1u [[PRBC]] | ||
*1u FFP (thaw | *1u [[FFP]] (thaw immediately after [[PRBC]] issued) | ||
*call for platelets for pack 2 | *call for platelets for pack 2 | ||
|| | || | ||
*1u PRBC | *1u [[PRBC]] | ||
*1u FFP | *1u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
|| | || | ||
*1u PRBC | *1u [[PRBC]] | ||
*1u FFP | *1u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*2.5u | *2.5u [[cryoprecipitate]] | ||
|| | || | ||
*1u PRBC | *1u [[PRBC]] | ||
1u FFP | *1u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*2.5u | *2.5u [[cryoprecipitate]] | ||
|| | || | ||
*1u PRBC | *1u [[PRBC]] | ||
*1u FFP | *1u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*2.5u | *2.5u [[cryoprecipitate]] | ||
|- | |- | ||
| '''Children 20-49 kg'''|||||||| | | '''Children 20-49 kg'''|||||||| | ||
|- | |- | ||
| | | | ||
*2u PRBC | *2u [[PRBC]] | ||
*2u FFP | *2u [[FFP]] | ||
*call for platelets for pack 2 | *call for platelets for pack 2 | ||
|| | || | ||
*2u PRBC | *2u [[PRBC]] | ||
*2u FFP | *2u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
|| | || | ||
*2u PRBC | *2u [[PRBC]] | ||
*2u FFP | *2u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*5u | *5u [[cryoprecipitate]] | ||
|| | || | ||
*2u PRBC | *2u [[PRBC]] | ||
*2u FFP | *2u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*5u | *5u [[cryoprecipitate]] | ||
|| | || | ||
*2u PRBC | *2u [[PRBC]] | ||
*2u FFP | *2u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*5u | *5u [[cryoprecipitate]] | ||
|- | |- | ||
| '''Children > 50 kg'''|||||||| | | '''Children > 50 kg'''|||||||| | ||
|- | |- | ||
| | | | ||
*4u PRBC | *4u [[PRBC]] | ||
*4u FFP | *4u [[FFP]] | ||
*call for platelets for pack 2 | *call for platelets for pack 2 | ||
|| | || | ||
*4u PRBC | *4u [[PRBC]] | ||
*4u FFP | *4u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
|| | || | ||
*4u PRBC | *4u [[PRBC]] | ||
*4u FFP | *4u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*10u | *10u [[cryoprecipitate]] | ||
|| | || | ||
*4u PRBC | *4u [[PRBC]] | ||
*4u FFP | *4u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*10u | *10u [[cryoprecipitate]] | ||
|| | || | ||
*4u PRBC | *4u [[PRBC]] | ||
*4u FFP | *4u [[FFP]] | ||
*1 platelet pack | *1 [[platelet pack]] | ||
*10u | *10u [[cryoprecipitate]] | ||
|} | |} | ||
===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]] | |||
==See Also== | |||
*[[Whole blood]] | |||
*[[TXA]] | |||
*[[Packed red blood cells]] | |||
*[[EBQ:PROPPR_Trial|The PROPPR trial]] | |||
*[[Coagulopathy (Main)]] | |||
*[[Hemorrhagic shock]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:Procedures]] | |||
[[Category:Heme/Onc]] | |||
[[Category:Trauma]] | |||
[[Category:Pediatrics]] | |||
[[Category:Critical Care]] | |||
Latest revision as of 10:54, 14 May 2022
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 | ||||
|
|
| ||
| Children 10-20 kg | ||||
|
|
|
| |
| Children 20-49 kg | ||||
|
|
|
| |
| Children > 50 kg | ||||
|
|
|
|
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