Red cells

Acute paediatrics

Studies support restrictive transfusion thresholds

• Use Hb threshold of 70 g/L in stable non-cyanotic patients.

• In non-bleeding infants and children, generally aim for a post-transfusion Hb of no more than 20 g/L above the threshold.

• Minimise blood sampling and use near patient testing where possible.

Surgery (non-cardiac)

• Use a peri-op Hb threshold of 70 g/L in stable patients without major comorbidity or bleeding.

• Use a peri-op Hb threshold of 70 g/L in stable patients without major comorbidity or bleeding.

• Consider tranexamic acid in all children undergoing surgery at risk of significant bleeding.

• Consider cell salvage in all children at risk of significant bleeding where transfusion may be required.

Transfusion volume calculation and prescribing

Volume to transfuse (mL)  =[desired Hb (g/L) – actual Hb (g/L)] × weight (kg) × 410

The formula provides a guide to the likely rise in Hb following transfusion for non-bleeding patients.

• Prescription should be in millilitres not units.

• Normal maximum volume for red cell top-up transfusion is 1 unit. Transfusion rate: 5 mL/kg/hr (usual max rate 150 mL/hr).