From the Guidelines
Blood Transfusion in Pediatric Patients with Fever
Blood transfusion in pediatric patients should not be withheld solely due to fever, as the decision to transfuse should be based on the patient's overall clinical condition and the urgency of the transfusion need 1.
Key Considerations
- Investigate and manage the underlying cause of the fever: It is crucial to identify and treat the cause of the fever, rather than just managing the symptoms.
- Administer antipyretics: Medications such as acetaminophen (15 mg/kg/dose, every 4-6 hours as needed) may help alleviate symptoms and make the patient more comfortable during the transfusion.
- Monitor temperature and vital signs: Close monitoring of the patient's temperature and vital signs during the transfusion is essential to quickly identify any potential complications.
- Pre-medication with diphenhydramine: Consider pre-medication with diphenhydramine (1 mg/kg/dose, maximum 50 mg) to reduce the risk of allergic reactions.
Transfusion Guidelines
- Restrictive transfusion strategy: The AABB suggests adhering to a restrictive transfusion strategy, with transfusion considered at a hemoglobin concentration of 7 g/dL or less in pediatric intensive care unit patients, or 8 g/dL or less in postoperative surgical patients, or for symptoms such as chest pain, orthostatic hypotension, or tachycardia unresponsive to fluid resuscitation 1.
- Transfusion volumes: Blood should be prescribed in volume rather than number of units, with a transfusion of 10 ml/kg-1 of RBC expected to increase Hb by approximately 20 g/l-1 1.
Special Considerations
- Neonates and children with congenital heart disease: Higher transfusion thresholds may be applied to these patients, although the exact thresholds are not clearly defined 1.
- Electrolyte imbalance and hypothermia: Children are at particular risk of electrolyte imbalance and hypothermia during rapid administration of blood products, and devices for vascular access and rapid administration of blood should be appropriate for the size of the child and rate of blood loss 1.
From the Research
Blood Transfusion in Pediatric Patients with Fever
- Blood transfusions are commonly indicated for critically ill children in pediatric intensive care units due to various reasons, including anemia and hemorrhagic diseases 2.
- The decision to transfuse should be based on the individual patient's medical indications and clinical context, taking into account their age, weight, and underlying condition 3.
- For pediatric patients with fever, the transfusion threshold may vary depending on the severity of illness and the patient's hemodynamic stability 4.
- A restrictive transfusion strategy, with a hemoglobin threshold of 70 g/L, may be appropriate for stable pediatric patients, excluding those with cyanotic heart disease or neonates 4.
- Red blood cells are the first choice for replacement therapy in decompensated anemic patients, while whole blood is used only in specific conditions, such as exchange transfusion or massive transfusion 2.
- Platelet transfusion is not needed when a patient has a platelet count greater than 10,000/mm3 and is without active bleeding, platelet functional deficiency, or other risk factors such as sepsis 2.
- The use of blood products, such as fresh frozen plasma and platelets, should be guided by the patient's clinical condition and laboratory results, with attention to the risks of transfusion-related complications 5, 6.
Special Considerations
- Neonates have a unique hemostatic system that differs from children and adults, and their transfusion requirements should be tailored to their individual needs 3.
- Preterm neonates require different red blood cell transfusion thresholds based on postnatal age and illness severity 3.
- Pediatric massive transfusion protocols should be in place in pediatric hospitals, with a standardized ratio of red blood cells, fresh frozen plasma, and platelets 3.
- The risks of transfusion-related complications, such as infection and allergic reactions, should be carefully considered and minimized through the use of blood-conservation strategies and alternative therapies 6.