What is the recommended initial dose of whole blood (WB) for a 4-month-old child weighing 2.890 kilograms (kg)?

Whole Blood Transfusion Dosing for Pediatric Patient

For a 4-month-old infant weighing 2.890 kg requiring whole blood transfusion, administer 10-15 mL/kg, which equals approximately 29-43 mL of whole blood.

Standard Pediatric Whole Blood Dosing

The calculation for this severely underweight infant follows established weight-based transfusion guidelines:

• Standard dose: 10-15 mL/kg of whole blood 1, 2
• For this 2.890 kg infant: 28.9-43.4 mL (round to 29-43 mL)
• Transfusion rate: Administer over 2-4 hours, monitoring closely for volume overload given the infant's small size 1

Critical Context for This Patient

This 4-month-old weighing only 2.890 kg is severely underweight for age (normal weight at 4 months is approximately 6-7 kg), placing this infant well below the 3rd percentile 3. This severe growth restriction requires several important considerations:

Blood Product Selection

• Low-titer O whole blood (LTOWB) is preferred when blood type is unknown or for rapid transfusion 1, 4
• Type-specific whole blood (TSWB) should be used once blood type is confirmed in hospital settings to minimize immunological complications 4
• Whole blood contains all necessary elements for oxygen delivery and hemostasis in physiologic ratios 1

Special Precautions for Severely Underweight Infants

• Volume overload risk: This infant has an estimated blood volume of only 231-289 mL (80-100 mL/kg), making careful monitoring essential 3
• Transfusion should be given slowly over 2-4 hours with continuous cardiorespiratory monitoring 1
• Consider dividing the dose if clinical status allows, giving 10 mL/kg initially and reassessing 3
• Monitor for signs of fluid overload including tachypnea, hepatomegaly, and increased work of breathing 3

Underlying Malnutrition Considerations

Given this infant's severe underweight status at 4 months:

• Iron deficiency is likely present, as infants this age with poor growth often have depleted iron stores 3
• After stabilization, iron supplementation at 2-3 mg/kg/day should be initiated for catch-up growth 3
• Small for gestational age infants require extra iron to achieve catch-up growth 3

Clinical Monitoring During Transfusion

• Vital signs: Every 15 minutes for first hour, then every 30 minutes 1
• Urine output: Should maintain >1 mL/kg/hour 3
• Respiratory status: Watch for signs of transfusion-associated circulatory overload (TACO) given small blood volume 1
• Temperature: Monitor for transfusion reactions 1

Product Availability and Storage

• Whole blood can be stored refrigerated for up to 35 days while retaining acceptable hemostatic function 1, 5
• Fresh whole blood from walking blood bank may be used when stored products unavailable 1
• Leucocyte-depleted whole blood is standard in most settings 6, 5

Common Pitfall to Avoid

Do not use adult component therapy dosing for this severely underweight infant—the 10-15 mL/kg whole blood dose is specifically designed for pediatric patients and accounts for their smaller blood volumes and different physiologic needs 1, 2. Using adult dosing formulas could result in dangerous volume overload in an infant with an estimated total blood volume of only 231-289 mL 3.