Approach to a child with a haemotological problem

3.1 Combined/multiple abnormalities

Bi- or pancytopaenia: systematic disease affecting bone marrow e.g. aplastic anaemia.

3.2 Abnormalities of red blood cells

Anaemia: haemorrhage, haemolysis, haematinic deficiencies or
haematological malignancy.

Polycythaemia: compensatory mechanism in hypoxia.

3.3 Abnormalities of white blood cells

Leukopaenia or leukocytosis and abnormal function: infection, tumours, allergies.

3.4 Abnormalities of platelets

Thrombocytopaenia or thrombocytosis & abnormal function: bleeding, infections.

3.5 Abnormalities with bleeding

Clotting factors from intrinsic, extrinsic and/or final common pathway and platelet number and/or function abnormal.

3.6 Abnormalities with thrombosis and embolism

Virchow’s triad: vessel/circulation/hypercoagulability - can be arterial or venous.

Common blood products dosing, volumes and storage

Red cell products:
Storage: between 1-6 degrees Celsius,
Administered by: blood administration sets.

  • Paediatric red cell concentrate (volume 25 - 150 mL).
  • Paediatric red cell concentrate: leucodepleted (75 mL).
  • Packed cells (volume in mL) = 4 x weight x desired increase in haemoglobin.
  • Whole blood (volume 485mL) leucodepleted: used in exchange transfusion volume to be infused = 6 x weight x deficit.

Platelet products:
Storage: do not refrigerate, use immediately.
Administration: special platelet administration set.

  • Paediatric platelets concentrate single donor apheresis leucodepleted (50 - 60 mL).
  • Platelet concentrate single donor apheresis leucodepleted (100-300 mL).
  • Random donor pooled platelets (200-300 mL).
  • Platelet concentrates = 5 - 10 mL/kg used for ordering, but administer the entire volume.

Plasma products:
Storage and administration: transfuse immediately after reconstitution and issue.

Clotting Factors:

  • Fresh Frozen Plasma (75mL) (kept in blood bank)
    • 15mL/kg/dose (100 iu/unit)
  • Fresh Dried Plasma (260mL) (can be kept on the shelf)
    • 15mL/kg/dose (100-160 mL)
  • Cryoprecipitate-fibrinogen rich (30 mL)
    • 1 u/10 kg/dose (150-200 iu/unit)
  • Factor VIII concentrate
    • 25-50 iu/kg/dose (100-500 iu/unit)
  • Factor IX concentrate
    • 40-60 iu/kg/dose