Clinical Guideline

PAEDIATRIC TRANSFUSION
SETTING Bristol Royal Hospital for Children

FOR STAFF Medical staff

PATIENTS All paediatric patients receiving care at Bristol Royal Hospital for Children
(note separate guidance for neonatal transfusion available, not included in this
document)

_____________________________________________________________________________

Table of Contents:

1. Red Blood Cell Transfusion Page 3

2. Fresh Frozen Plasma Page 6

3. Cryoprecipitate Page 8

4. Prothrombin Complex Concentrate (PCC) Page 9

5. Platelets Page 10

6. Granulocyte (White Cell) Transfusions Page 12

7. Human Albumin Solution (HAS) Page 13

8. Gamma-Irradiation of Blood Products Page 13

9. CMV Negative Blood Products Page 14

References Page 15

Related BRHC Guidelines Page 15

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Abbreviations Used Throughout Guideline:

aPTT Activated Partial Thromboplastin Time

BMT Bone Marrow Transplant
CMV Cytomegalovirus
CNS Central Nervous System
CVVH Continuous Veno-Venous Haemofiltration
DIC Disseminated Intravascular Coagulation
ECLS Extra Corporeal Life Support
FFP Fresh Frozen Plasma
FISH Fluorescence In Situ Hybridization
ITP Immune Thrombocytopenia Purpura
INR International Normalised Ratio
IUT Intra Uterine Transfusion
HAS Human Albumin Solution
Hb Haemoglobin
Hct Haematocrit
HDN Haemolytic Disease of the Newborn
HIT Heparin Induced Thrombocytopenia
HLA Human Leukocyte Antigen
HSCT Haemopoietic Stem Cell Transplant
HUS Haemolytic Uraemic Syndrome
PCC Prothrombin Complex Concentrate
PICU Paediatric Intensive Care Unit
PT Prothrombin Time
SCD Sickle Cell Disease
SCT Stem Cell Transplant
TA-GVHD Transfusional Graft Versus Host Disease
TTP Thrombotic Thrombocytopenic Purpura
vCJD Variant Creutzfeldt-Jakob Disease
VSD Ventricular Septal Defect

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1. RED BLOOD CELL TRANSFUSIONS:

1.1 General Principles:

1.1.1. If the reason for anaemia is not known, ensure blood samples for investigation are taken
prior to transfusion

1.1.2. If a treatable cause is identified, e.g. B12, folate, iron deficiency, haemolytic anaemia –
start appropriate treatment immediately. It may be possible to avoid transfusion, regardless
of haemoglobin level.

1.1.3. The prescribing doctor should give family/patient information about the risks and benefits of
red cell transfusion and document the indication in the patient notes.

1.1.4. Patients with sickle cell disease (SCD), thalassaemia and others requiring long term
transfusion support should have full red cell phenotyping performed prior to transfusion.

1.2 Suggested Transfusion Thresholds

1.2.1. The decision to transfuse red blood cells should not be solely based on the haemoglobin
but should take into account the patient’s symptoms and clinical features.

Suggested Haemoglobin Transfusion Thresholds in Paediatrics

70 g/l 90 g/l
• Stable patients / asymptomatic • Unstable patients
anaemia • Symptomatic anaemia
• Stable non-cyanotic heart disease • Patients with cyanotic congenital
patients following heart disease
CardioPulmonary Bypass (CPB) • Severe sepsis with high plasma
• Elective non-cardiac surgery lactate and/or mixed venous
perioperative patients* saturations < 50%
• Oncology/Haemopoietic Stem Cell
Transplant (HSCT) patients

1.2.2. Specific Conditions:

• Neonatal patients often require higher transfusion thresholds – see separate BRHC
Guideline - Transfusion Guidelines for Neonates)
• Patients with specific conditions such as chronic anaemia, B12 or folate deficiency,
haemoglobinopathies, Diamond Blackfan anaemia may require different transfusion
thresholds and may be at risk of developing complications – transfusion should be
discussed with a haematologist in these circumstances.
• Extra Corporeal Life Support (ECLS) patients – maintain Hb > 100 g/l

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1.2.3. *Note on Surgical Patients:

• Optimise pre-operative Hb by treating iron deficiency anaemia

• For some operations, (e.g. neuroblastoma resection where there is a risk of significant
bleeding) the team may consider transfusing to a higher Hb pre-operatively
• Consider tranexamic acid if undergoing surgery with risk of significant bleeding
• Consider red cell salvage if undergoing surgery with risk of significant bleeding

1.3. Selection of Units for Red Blood Cell Transfusion:

1.3.1. Patients less than 4 months of age:

• Blood should be compatible with maternal and neonatal ABO and D group and clinically
significant maternal antibodies
• If considered likely to require multiple top-up transfusions, should be given small volume
(50ml) paediatric multi-packs to minimise donor exposure

1.3.2. Patients from 4 months of age:

• Blood should be compatible with recipient’s ABO and D group and any red cell
alloantibodies

1.3.3. RhD-negative red cells should be selected for all RhD-negative patients less than 18 years
old and all females of child-bearing age.

1.3.4. All females under 60 years of age should receive K-negative red cells

1.3.5. Patients with SCD, thalassaemia, autoimmune haemolytic anaemia and others requiring
long term transfusion should have Rh and Kell matched blood

1.3.6. All available red blood cell products are leucodepleted (<5x106 per unit)

1.3.7. Consider whether the blood is required to be irradiated and/or CMV negative – see
Sections 8 and 9

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 1.3.8. Red Cell Products Available for Paediatric Use:

CMV Volume Comments/Clinical Uses

Status
Paediatric Packs Negative 25-100ml Hct 50-70%
‘Paedipacks’ Multi-packs from same donor should
be requested if repeated top ups are
anticipated in patients < 5kg
Consider in patients 5-10kg
Not suitable for patients over 10kg
Must be irradiated if previous Intra-
Uterine Transfusion (IUT)
Shelf life post irradiation 14 days
Red Cells in Tested on 220- Hct 50-70%
additive solution request 340ml Correction of anaemia, replacement of
blood loss

Stock item (standard adult unit) unless

irradiation required
Must be irradiated if previous IUT
Shelf life post irradiation 14 days
Red Cells for Negative 200- Hct 50-60%
Exchange 450ml Less than 5 days old
Transfusion Exchange transfusion usually for
Haemolytic Disease of the Newborn
(HDN)
Available from National Blood Service
Must be irradiated if previous IUT
Shelf life post irradiation 24 hours
Large volume red Negative 200- Hct 50-60%
cell transfusion in 300ml Less than 5 days old
neonate/infant Shelf life post irradiation 24 hours

1.4. Volume of Red Blood Cell Transfusion:

1.4.1. In non-bleeding patients it is recommended that the target post-transfusion Hb is not more
than 20 g/l above the transfusion threshold.

1.4.2. The following formula should be used to calculate the volume of RBCs required for
transfusion [Davis et al. Transfusion 2007;47:212-6]:

Volume to transfuse (ml) = [ Desired Hb (gl) – Current Hb (g/l) ] x weight (kg) x 5

10

Make sure you are using the correct units for Hb when using this calculation i.e. g/l

1.4.3. After calculating, double check that the final volume calculated is not more than 20ml/kg
(usually a volume of 15ml/kg is adequate for paediatric top up transfusion).

1.4.4. This volume should also not exceed the maximum normally prescribed for adult in a similar
situation ie 1 unit (approx. 280ml) red cells for a paediatric top up transfusion.

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1.5. Transfusion Rate:

1.5.1. Aim to give typical top up red blood cell transfusion over 3 hours, but may be quicker
depending on clinical situation:
• Could consider giving over 2 hours in patients who are regularly transfused
• See separate BRHC Guideline – Major Haemorrhage Procedure
1.5.2. Typical top up transfusion rate: 5ml/kg/hr (usually maximum rate: 150ml/hr)

2. FRESH FROZEN PLASMA

2.1. General Points:

2.1.1. Fresh Frozen Plasma (FFP) is produced from whole blood and contains coagulation factors
as well as other plasma proteins such as immunoglobulins and albumin.

2.1.2. The aetiology of a coagulopathy should be known prior to the use of FFP or undertaking
invasive procedures.

2.1.3. Coagulopathy in children is often defined as a PT(INR) or aPTT ≥1.5x the mid-point of the
normal range.

2.2 Indications:

2.2.1 DIC:
• Consider FFP if the PT/aPTT is ≥1.5x normal, and the child is bleeding, or if an
invasive procedure is planned
• If fibrinogen is low, then cryoprecipitate and/or fibrinogen concentrate may be
required, or be a better alternative
2.2.2 Burns patients where Toxic Shock Syndrome/Sepsis is proven or suspected:
• (See separate BRHC Guideline – Burns: Paediatric Toxic Shock Syndrome and
Sepsis)
2.2.3 During/Post cardiac bypass surgery:
• If significant bleeding and PT ≥1.5x normal
2.2.4 ECMO patients:
• Use FFP (with vitamin K) if INR ≥ 1.5
• See separate BRHC Guideline - ECMO Guideline
2.2.5 Major Blood Loss/Massive Transfusion:
• Early use of FFP (and platelets and cryoprecipitate) is recommended to reduce
coagulopathy and thrombocytopenia
See separate BRHC Guideline – Major Haemorrhage Procedure

2.2.6 Vitamin K Deficiency Bleeding (including HDN):

• At risk groups include neonates, children with cholestatic liver disease, pancreatic
insufficiency, malabsorption, malignancy and prolonged antibiotic use.
• It is suggested by a rise in PT followed by a rise in aPTT.
• If no bleeding: give IV vitamin K 250micrograms/kg

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 • If active bleeding: give FFP as well as IV vitamin K
2.2.7 Heritable bleeding disorders:
• Severe hereditary protein S deficiency
• Severe hereditary protein C deficiency (however protein C concentrate should be
used in preference if available)
• Anti-thrombin III deficiency – especially if patient is on heparin
2.2.8 Thrombotic thrombocytopenic purpura:
• Often requires urgent plasma exchange with solvent detergent treated FFP –
discuss with haematology
2.2.9 Liver disease:
• FFP often poorly corrects clotting abnormalities in this instance and large fluid
volumes are not well tolerated.
• Vitamin K is often a key component of treatment.
• Expert advice should be sought from a Paediatric Liver Unit (Birmingham Children’s
Hospital or King’s College London) if required.

2.2.10 Prophylactic FFP should not be given to non-bleeding children with minor prolongation of
the PT/aPTT including prior to surgery (although it may be considered if surgery to critical
sites is planned e.g. neurosurgery/ophthalmic surgery)

2.3 Selection of FFP for Transfusion:

2.3.1 Standard FFP is now acceptable for most uses in children

2.3.2 ABO-compatible FFP should be used whenever possible. Group O plasma should only be
given to group O recipients as it will contain donor derived anti A and B.
2.3.3 There is so little red cell stroma in FFP that there is no need to RhD match

2.4 Volume and Rate of Transfusion:

2.4.1 Transfusion volume: 15-20ml/kg (use higher volume in bleeding patients, but caution if at
risk of volume overload)
2.4.2 Transfusion volume: 10ml/kg transfusion volume is suggested for ECMO and Burns/TSS
patients, see separate BRHC guidelines:
• ECMO Guideline
• Burns: Paediatric Toxic Shock Syndrome and Sepsis
2.4.3 Transfusion rate: 10-20ml/kg/hr
2.4.4 Use within 4 hours of defrosting if factor VIII replacement is needed e.g. Disseminated
Intravascular Coagulation (DIC). Otherwise may be stored at 4ᵒC before administration to
the patient providing the infusion is completed within 24 hours.
2.4.5 Coagulation studies must be carried out before and after transfusion of FFP

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2.5 FFP Products Available for Paediatric Use:

CMV Virally Volume Comments/Clinical Uses

Status Inactivated
FFP (Octaplas) Not Yes 200ml Pooled FFP from multiple non-UK
Solvent required donors
detergent FFP Do not use in Protein S Deficiency
Plasmapheresis
Considered in atypical Haemolytic
Uraemic Syndrome (HUS)
patients
Stock item (standard adult unit)
Methylene Not Yes 50-75ml Single donor non-UK donor FFP
blue-treated required (neonatal) Alternative for patients if Octoplas
FFP unavailable
200-300ml
(paediatric)
Needs to be specially ordered

This is the main product for

neonatal top up transfusions at
the time of writing, as this is the
only product where a smaller pack
is produced. This may change if
NHSBT start production of FFP
packs again
Fresh frozen Not No 220-340ml Usual product of choice for top up
plasma, required infusions
leukocyte
depleted

3. CRYOPRECIPITATE
3.1 General Points

3.1.1 Cryoprecipitate is a major source of fibrinogen but also contains other clotting factors such
as Factor XIII, von Willebrand Factor and Fibronectin
3.1.2 One of its most common uses is therefore to enhance fibrinogen levels in
dysfibrinogenaemia and in acquired dysfibrinogenaemia (e.g. DIC) and massive
transfusion).

3.2 Indications

3.2.1 Treatment is usually indicated if fibrinogen < 1g/L

3.2.2 DIC with bleeding – consider cryoprecipitate if persistent hypofibrinogenaemia despite FFP
or if very low (<0.5g/L) or rapidly falling fibrinogen levels.
3.2.3 Major haemorrhage/Massive transfusion – fibrinogen threshold for transfusion < 1.5g/L, see
separate BRHC Guideline – Major Haemorrhage Procedure
3.2.4 Bleeding during/following cardiac surgery

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3.2.5 Prophylaxis prior to surgery - only if risk of significant bleeding or surgery to critical site
(central nervous system, eyes) – fibrinogen threshold for transfusion < 1.0g/l
3.2.6 Inherited hypofibrinogenaemia – fibrinogen threshold for transfusion < 1.0g/l. Should only
be used if fibrinogen concentrate is unavailable.
• Fibrinogen concentrate should be considered for patients with congenital
afibrinogenaemia or hypofibrinogenaemia during acute bleeding episodes or as
prophylaxis prior to surgery
3.2.7 Von Willebrand Factor replacement in renal failure where DDAVP contraindicated

3.3 Product Available

CMV Volume Comments/Clinical Uses

Status
Cryoprecipitate, Not 40ml Replacement of fibrinogen and von
leukodepleted required Willebrand factor.
ABO-compatible wherever possible.
However because of the small
volumes involved, the use of group O
donations for other patients should not
cause problems unless daily high
dosage infusions are given.

3.4 Volume of Transfusion and Administration

3.4.1 Typical transfusion volume: 5ml/kg (maximum 2 pools)

3.4.2 Transfusion rate: 10-20ml/kg/hr – usually given over 30 minutes
3.4.3 Infusion must be completed as soon as possible and within 4 hours of thawing
3.4.4 Fibrinogen levels must be tested before and after transfusion

4. PROTHROMBIN COMPLEX CONCENTRATE (PCC)

4.1. PCC’s are pooled plasma products containing factors II, VII, IX and X and are the usual
treatment of choice to reverse oral anticoagulation.

4.2. Indications for use:

• Life threatening haemorrhage in patients on warfarin

• Trauma, particularly when associated with head injury in patients on warfarin

• Prior to an emergency invasive procedure in patients on warfarin

4.3. PCC is available from blood bank

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4.4. The haematology registrar/consultant on call should be contacted to authorise use

4.5 The recommended dose for complete reversal of anticoagulation is 50 units/kg

5. PLATELETS
The cause of thrombocytopenia should be established prior to platelet transfusion

5.1 Indications:

5.1.1. It is important to consider the clinical setting and patient factors as well as platelet count
when considering the need for platelet transfusion.

5.1.2. Different thresholds are used in neonatal patients – see separate BRHC Guideline –
Transfusion Guidelines for Neonates

5.1.3. Thresholds for infant/paediatric platelet transfusion:

Platelet Clinical situation to trigger platelet transfusion

count
(x109/L)
<10 Irrespective of signs of haemorrhage
(excluding Immune Thrombocytopenia Purpura (ITP), Thrombotic
Throbocytopenic Purpura (TTP)/HUS, Heparin Induced
Thrombocytopenia (HIT) ) – see section 5.2
<20 Severe mucositis
Sepsis
Laboratory evidence of DIC in the absence of bleeding
Anticoagulant therapy
Risk of bleeding due to a local tumour infiltration
Insertion of a non-tunnelled central venous line
<40 Uncomplicated lumbar puncture (except in new leukaemia patients,
see below)
<50 First lumbar puncture in newly diagnosed leukaemia patients
Active bleeding
Moderate haemorrhage (e.g. gastrointestinal bleeding) including
bleeding associated with DIC
Children undergoing Continuous Veno-Venous Haemofiltration
(CVVH)
Surgery, unless minor (except at critical sites)
Tunnelled central venous line insertion
<100 Major haemorrhage or significant post-operative bleeding (e.g. post
cardiac surgery)
Surgery at critical sites: central nervous system, including eyes
Bleeding secondary to multiple trauma
Children who are actively bleeding and have CNS injury
ECLS patients (increased platelet threshold to 120x109/L if active
bleeding on ECLS)

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5.2. Contraindications to platelet transfusion – except in life-threatening bleeding:

• Immune Thrombocytopenia Purpura (ITP)

• Thrombotic Thrombocytopenic Purpura (TTP) / Haemolytic Uraemic Syndrome (HUS)
• Heparin-induced thrombocytopenia (HIT)

5.3. Selection of Platelets for Transfusion:

5.3.1. Try and use the same ABO group as the patient. It is more important to give compatible
plasma than compatible platelets. Avoid group O platelets for A, B or AB recipients – if
unavoidable units should be confirmed as having a low titre of anti-A and anti-B.

5.3.2. Rh D negative recipients should get Rh D negative platelets wherever possible. If Rh D

positive platelets are given to Rh D negative females of childbearing potential, prophylactic
anti-D should be given by S/C injection. See UHB Adult Blood Transfusion Guidelines,
section on Use of Prophylactic anti-D immunoglobulin (Anti-D Ig)
5.3.3. Consider whether platelets are required to be irradiated and/or CMV negative – see
Sections 8 and 9
5.3.4. Platelet Products Available for Paediatric Use:

CMV Volume Comments/Clinical Uses

Status
Paediatric Tested on 35-90ml Treatment of thrombocytopenia or
Apheresis request bleeding associated with platelet
platelets dysfunction
(equivalent to
0.25 adult dose) Obtained by apheresis from single
donor, split into 4 smaller units
Suitable for neonatal and infant
transfusion

Must be irradiated if previous IUT

Platelets – Tested on 150- Treatment of thrombocytopenia or
Apheresis/pooled request 350ml bleeding associated with platelet
dysfunction

Must be irradiated if previous IUT

5.4 Volume to Transfuse and Rate:

5.4.1 Typical transfusion volume: 10-20ml/kg (maximum volume 1 pack i.e. 350ml)

5.4.2 Transfusion rate: 10-20ml/kg/hr – usually over 30 minutes (never quicker than over 30
minutes)

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6. GRANULOCYTE (WHITE CELL) TRANSFUSIONS
6.1. Indications for use:

6.1.1. Granulocyte transfusions may be considered as supportive therapy for patients with severe
neutropenia or in patients with neutrophil dysfunction.

Consider in patients who:

•
Are neutropenic (except in Chronic Granulomatous Disease) and
•
Have evidence of bacterial or fungal infection and
•
Are unresponsive to antimicrobial treatment for 48 hours (or could be considered earlier
in life-threatening infection)
6.1.2. Should always be approved by haematology/oncology consultant

6.2. Available product:

CMV Volume Comments/Clinical Uses

Status
Pooled buffy coat Negative 1 pool Limited availability (Tues-Sat as
derived for = 205ml product has 24 hour expiry shelf life)
granulocytes neonates (approx.) Requires at least 24 hours notice
or if 10 donations pooled – each pack
otherwise contains approximately 1 x 1010
require granulocytes
CMV Buffy coat contains large amounts of
negative red cells and platelets:
• Hct <0.20 therefore venesection
unlikely to be required
• Each pack contains equivalent
of 2.5 adult packs of platelets
Irradiated product – to prevent
transfusion-associated graft-vs-host
disease due to lymphocyte numbers

6.3. Volume and Administration:

6.3.1. Typical transfusion volume: 10-20ml/kg (to a maximum of 2 pools)

6.3.2. Transfusion rate: 10-20ml/kg/hr (should be given over 1-2 hours)

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7. HUMAN ALBUMIN SOLUTION (HAS)
7.1 4.5% Human Albumin Solution

7.1.1 Indications:

• On PICU or as part of initial resuscitation where fluid bolus requirement exceeds

50ml/kg/day, especially in patients with septic shock or protein-losing state.
• Burns
• Plasma exchange
• Paracentesis
• Treatment of hypovolaemia in nephrotic patients (see separate BRHC Guideline –
Nephrotic Syndrome)

7.2 20% Human Albumin Solution (20% albumin solution contains 20g albumin in 100ml)

7.2.1 Indications:

• Replacement for paracentesis

• Treatment of diuretic resistant oedema, ascites or pleural effusions in hypoalbuminaemic
patients. See separate BRHC guidelines:
o HAS 20% - Human Albumin Solution (Nephrotic Syndrome)
o Human Albumin Solution (HAS) 20% (20grams/100ml) Administration

8. GAMMA-IRRADIATION OF BLOOD COMPONENTS

8.1. Aim:
8.1.1. To avoid transfusional graft versus host disease (TA-GVHD) caused by engraftment of
viable donor lymphocytes.
8.1.2. FFP, cryoprecipitate and fractionated plasma products have not been implicated in TA-
GVHD, and therefore do not require gamma-irradiation.

8.2. Indications:

8.2.1. Congenital immunodeficiency states:

o Known documented T cell dysfunction
o Known antenatal or postnatal 22q1.1 deletion without evidence of normal T cell
function
o Disease with high index of suspicion for 22q1.1 deletion without documentation of
either normal FISH 22q11 result or T cell function:
 Absent pulmonary valve syndrome
 Interrupted aortic arch
 Doubly committed sub-arterial Ventricular Septal Defect (VSD)
 Tetralogy of Fallot
 Truncus arteriosus
 Aorto-pulmonary window
 Double aortic arch and its variants

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8.2.2. Previous Intra Uterine Transfusion (IUT) for infants up to 6 months of age post-IUT
8.2.3. Exchange transfusions – essential if the donation comes from a first or second degree
relative or if there has been a previous Intra Uterine Transfusion (IUT). In other
circumstances, irradiation is recommended provided this does not delay the transfusion.
8.2.4. Top-up transfusions –if the donation is from a first or second degree relative
8.2.5. Therapy or disease induced immunodeficiency:
• Recipient of allogeneic bone marrow (BMT)/stem cell transplant (SCT)
• Recipient of autologous BMT/SCT
• Patients undergoing harvesting for BMT/SCT. During harvest and for 7 days before.
• Patients with Hodgkins Disease
• Patients treated with anti-thymocyte globulin
• Patients treated with the following drugs:
o Fludarabine
o Cheno-oxy-adenosine 2 (CdA)
o Deoxycoformycin
o Clofarabine
o Nelarabine
o Pentostatin
o Bendamustine
o Alemtuzumab
8.2.6. Blood components that always require irradiation:
• Directed donations from family members
• Granulocyte infusions
• HLA matched products i.e. red cells, platelets
8.3. Process:

8.3.3. Patients should be given an information leaflet and card.

8.3.4. The blood bank should be informed of the need for irradiated products.
8.3.5. An alert should be added to the patient’s Medway home page stating “irradiated blood
products only”. If the patient’s written case notes are still in use these should also be
updated by writing “irradiated blood products only” clearly in the front of the notes along
with the authorising doctor’s signature.

9. CMV NEGATIVE BLOOD PRODUCTS

9.1. CMV Negative Components

9.1.1. Following universal leukodepletion, CMV negative products are now only recommended for
the following paediatric patient groups:
• Neonates < 28 days from their estimated delivery date

9.1.2. Granulocyte transfusions for CMV negative products outside the above indications will
require authorisation from the consultant with responsibility for blood bank

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REFERENCES • Guidelines on transfusion for fetuses, neonates and older children. New
et al. British Journal of Haematology, 2016, 175, 784-828

• Blood Transfusion. NICE Guideline NG24. Published: 18 November

2015. nice.org.uk/guidance/ng24

• Joint United Kingdom (UK) Blood Transfusion and Tissue

Transplantation Services Professional Advisory Committee (JPAC).
http://www.transfusionguidelines.org.uk/red-book

• Calculating the required transfusion volume in children. Davies et al.

Transfusion 2007;47:212-6

• Blood Transfusion: Clinical Guidelines (Including Blood Products).

Clinical Guidelines, University Hospitals Bristol NHS Foundation Trust

• Clinical Guidelines for the Use of Granulocyte Transfusions: Prepared by

the Granulocyte Working Group, M Elebute et al. Last revised
December 2016

RELATED Neonatology – Transfusion Guidelines for Neonates

DOCUMENTS
AND PAGES Emergency – Major Haemorrhage Procedure

Cardiology – Blood Cross Matching for Elective Cardiac Surgery

PICU – ECMO Guideline

Burns/Plastics – Burns: Paediatric Toxic Shock Syndrome and Sepsis

Renal – Nephrotic Syndrome

HAS 20% - Human Albumin Solution (Nephrotic Syndrome)

Renal – Human Albumin Solution (HAS) 20% (20grams/100ml)

Administration

AUTHORISING Paediatric Haematology, Oncology and Bone Marrow Transplant Quality

BODY Assurance Forum (Quaf)

SAFETY N/A

QUERIES AND Paediatric haematology registrar via bleep 2677.

CONTACT Non urgent queries to Dr Tom Latham (consultant haematologist) or Soo
Cooke (transfusion practitioner)

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