Massive transfusion (peds)

This page is for pediatric patients. For adult patients, see: massive transfusion

Overview

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

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

MTP Pack 1	MTP Pack 2	MTP Pack 3	MTP Pack 4	MTP Pack 5
Children < 10 kg
25 mL/kg PRBC 20 mL/kg FFP call for platelets for pack 2	25 mL/kg PRBC 20 mL/kg FFP 10 mL/kg platelets	25 mL/kg PRBC 20 mL/kg FFP 10 mL/kg platelets 4 mL/kg cryoprecipitate	25 mL/kg PRBC 20 mL/kg FFP 10 mL/kg platelets 4 mL/kg cryoprecipitate	25 mL/kg PRBC 20 mL/kg FFP 10 mL/kg platelets 4 mL/kg cryoprecipitate
Children 10-20 kg
1u PRBC 1u FFP (thaw immediately after PRBC issued) call for platelets for pack 2	1u PRBC 1u FFP 1 platelet pack	1u PRBC 1u FFP 1 platelet pack 2.5u cryoprecipitate	1u PRBC 1u FFP 1 platelet pack 2.5u cryoprecipitate	1u PRBC 1u FFP 1 platelet pack 2.5u cryoprecipitate
Children 20-49 kg
2u PRBC 2u FFP call for platelets for pack 2	2u PRBC 2u FFP 1 platelet pack	2u PRBC 2u FFP 1 platelet pack 5u cryoprecipitate	2u PRBC 2u FFP 1 platelet pack 5u cryoprecipitate	2u PRBC 2u FFP 1 platelet pack 5u cryoprecipitate
Children > 50 kg
4u PRBC 4u FFP call for platelets for pack 2	4u PRBC 4u FFP 1 platelet pack	4u PRBC 4u FFP 1 platelet pack 10u cryoprecipitate	4u PRBC 4u FFP 1 platelet pack 10u cryoprecipitate	4u PRBC 4u FFP 1 platelet pack 10u cryoprecipitate

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

This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.