Blood Transfusion Rate for a 15-Year-Old with Chronic Uterine Bleeding
In a 15-year-old with chronic uterine bleeding, one unit of red blood cells should be transfused at a rate of 10 ml/kg over 2-4 hours, with the entire transfusion completed within 4 hours of starting. 1
Transfusion Volume and Rate Guidelines
For pediatric patients, blood transfusion should be prescribed by volume rather than by units. The AAGBI guidelines specifically recommend:
- A transfusion volume of 10 ml/kg of red blood cells for children, which should increase hemoglobin by approximately 20 g/L 1
- The transfusion must be completed within 4 hours of starting to prevent bacterial growth 1
- For most pediatric patients, this means a transfusion rate of 2-4 ml/kg/hour
Weight-Based Calculation Example
For a 15-year-old female (assuming average weight of 50-60 kg):
- Total volume: 10 ml/kg × 50-60 kg = 500-600 ml
- Recommended duration: 2-4 hours
- Transfusion rate: approximately 125-300 ml/hour
Special Considerations for Chronic Uterine Bleeding
Adolescents with chronic uterine bleeding require particular attention to:
- Hemodynamic status assessment before determining transfusion rate
- Potential for ongoing blood loss requiring adjustment of rate
- Risk of fluid overload if transfused too rapidly
- Potential underlying coagulopathy that may need concurrent management
Monitoring During Transfusion
- Vital signs should be monitored before starting, 15 minutes after starting, and then hourly until completion
- Hemoglobin should be checked before and after transfusion to assess response 1
- Watch for signs of transfusion reaction (fever, urticaria, back pain, hypotension)
- Monitor for signs of fluid overload, particularly in patients with chronic anemia who may have adapted to lower hemoglobin levels
Important Caveats
- Single-unit transfusion approach: Transfuse one unit at a time and reassess, unless there is active, severe bleeding 1
- Time outside temperature-controlled environment: Should be restricted to 30 minutes maximum 1
- Filter requirement: Transfusion should be administered through a 170-200μm filter 1
- Electrolyte monitoring: Adolescents are at particular risk for electrolyte imbalance during blood product administration 1
For patients with severe bleeding causing hemodynamic instability, the transfusion rate may need to be faster, but this would be considered an emergency situation rather than management of chronic uterine bleeding.