When should a massive transfusion protocol be activated?
Massive transfusion protocols are activated by a clinician in response to massive bleeding. Generally this is activated after transfusion of 4-10 units. MTPs have a predefined ratio of RBCs, FFP/cryoprecipitate and platelets units (random donor platelets) in each pack (e.g. 1:1:1 or 2:1:1 ratio) for transfusion.
What is the appropriate needle size for pediatric patients receiving blood transfusions?
The smallest gauge, 25, is used primarily with pediatric patients. 1 The short needle length allows the phlebotomist to insert it at a shallow angle that can increase the ease of use.
How many units is massive transfusion protocol?
Massive transfusion is traditionally defined as transfusion of 10 units of packed red blood cells (PRBCs) within a 24 hour period. The goal of massive transfusion is to limit complications and to limit critical hypoperfusion while surgical hemostasis can be achieved.
How do you transfuse a child?
During a blood transfusion, your child receives donated blood through one of his or her blood vessels. A needle is put into a vein, often in the arm. The needle is attached to a thin, flexible tube called a catheter. This is called an intravenous line, or IV.
What labs do you monitor after a massive transfusion?
Massive Transfusion Protocol
|Parameters||Values to aim for|
|Haemoglobin (Hb)||This should not be used alone as transfusion trigger; and, should be interpreted in context with haemodynamic status, organ & tissue perfusion.|
|Platelet (Plt)||≥ 50 x 10^9 /L (>100 x 10^9 if head injury/ intracranial haemorrhage)|
|PT/APTT||≤ 1.5x of normal|
Why do we give calcium gluconate after blood transfusion?
Calcium levels can be significantly decreased with rapidly transfused blood products due to the citrate preservative that is added. Citrate binds to the patient’s endogenous calcium when blood products are administered, rendering calcium inactive.
When do you give FFP vs Cryo?
FFP contains coagulation factors at the same concentration present in plasma. Cryoprecipitate is a highly concentrated source of fibrinogen….
|Other coagulation factors||All, including factors II, VII, VIII, IX, X, XI, and vWF||Factors VIII, XIII, and vWF|
When do you transfuse pediatrics?
Expert opinion now generally favours an Hb transfusion trigger of 70 g/L in stable critically ill children, which is the same as the recommendation for adult patients (see Chapter 7). A higher threshold should be considered if the child has symptomatic anaemia or impaired cardiorespiratory function.
At what hemoglobin do you transfuse in children?
A hemoglobin threshold of 8 g/dl or less is recommended for transfusion if patients are symptomatic . There is no agreed hemoglobin level for PRBC transfusions in children admitted to a PICU. The threshold for transfusion may vary with underlying diagnosis and physiologic stability.
Why is Lasix given after blood transfusion?
For many years, furosemide has been used routinely by physicians during and after blood transfusions in neonates and other age groups. The rationale behind this common practice is to reduce the vascular overload that may be imposed by the additional blood volume delivered during transfusion.
Do pediatric massive transfusion protocols evolve with protocol variation?
In pediatric massive transfusion, Horst et al have studied the majority of the conclusions we have about variation in protocol for pediatric massive transfusion protocols. First, without accurate pediatric MT prediction scoring systems, physician discretion is the current predominant factor for protocol activation.
What is a pediatric massive transfusion?
The definition of pediatric massive transfusion is empiric based on a review of blood use patterns at our hospital.
Should we standardize blood transfusions in pediatric trauma?
Standardization is needed as transfusions and activation of protocols still rely on physician discretion in most pediatric settings. Further research is required to define the pediatric trauma population that will benefit, when to activate these protocols and how to use adjuncts such as tranexamic acid or factor VII in resuscitation.
Is blood transfusion via an MTP associated with fewer thromboembolic events?
This study found that blood transfusion via an MTP is associated with fewer thromboembolic events in the pediatric population. Coagulopathy was a predictor of MTP activation. Factor VII had no effect on mortality and was correlated with higher blood product use.