Recommended Whole Blood Volume for a 9-Year-Old, 22 kg Patient
For a 9-year-old child weighing 22 kg, the recommended volume of whole blood is 220 mL (10 mL/kg), which should increase hemoglobin by approximately 20 g/L and be administered over 2-4 hours. 1, 2
Standard Pediatric Transfusion Volume Calculation
The fundamental dosing principle is 10 mL/kg of red blood cells or whole blood, which produces an approximate hemoglobin increase of 20 g/L (2 g/dL). 1, 2
For this specific patient: 22 kg × 10 mL/kg = 220 mL of whole blood 1
Blood should be prescribed by volume (mL) rather than units in pediatric patients to ensure appropriate dosing. 1
Alternative Calculation Method for Precise Dosing
If a specific hemoglobin increment is desired, use the validated formula: weight (kg) × desired Hb increment (g/dL) × 3 / (hematocrit of blood product) 3
For whole blood with typical hematocrit of 0.35-0.40, this formula confirms that approximately 10 mL/kg achieves a 2 g/dL increase 3
This calculation method was validated in 379 pediatric transfusions and showed no significant variation based on patient age, weight, starting hemoglobin, or sex 3
Administration Rate and Timing
The initial transfusion rate should be 4-5 mL/kg/hour for stable pediatric patients, which for this 22 kg patient equals approximately 88-110 mL/hour 2
The entire transfusion should be completed over 2-4 hours, with each unit finished within 4 hours of removal from controlled storage 2
For this patient receiving 220 mL, the transfusion would take approximately 2-2.5 hours at standard pediatric rates 2
Critical Safety Considerations
All blood must be administered through a 170-200 μm filter giving set to prevent particulate matter infusion 2
Slower transfusion rates should be considered if the patient has cardiovascular compromise or reduced cardiac output 2
Blood warmers with visible thermometers should be used when transfusing volumes exceeding 15 mL/kg (>330 mL for this patient) to prevent hypothermia 2
Vital signs monitoring should occur before, during, and after transfusion 2
Volume Adjustment for Specific Clinical Scenarios
In massive hemorrhage or hemorrhagic shock, whole blood can be administered up to 40 mL/kg (880 mL for this 22 kg patient) during initial hemostatic resuscitation 4
Whole blood achieves balanced resuscitation faster than component therapy (median 28 vs 87 minutes) with fewer donor exposures in critically injured children 5
For ongoing bleeding requiring multiple transfusions, avoid exceeding the patient's estimated blood volume of 70 mL/kg (1,540 mL for this patient) without careful monitoring 1
Common Pitfalls to Avoid
Never transfuse blood that has been outside controlled storage for more than 4 hours, as this dramatically increases contamination and hemolysis risk 2
Administering transfusions too rapidly in stable patients can cause transfusion-associated circulatory overload (TACO), particularly in patients with cardiac or renal disease 2
Rounding to the nearest whole unit is acceptable for efficiency, but precise volume calculation prevents both under-transfusion and hypervolemia 1
Hemoglobin should be measured 1 hour after transfusion completion, as this correlates with 7-hour post-transfusion values 3