Cheema et al proposed a blood transfusion protocol for pediatric patients in Africa. This is based on a protocol published by the World Health Organization (WHO). The authors are from Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, University of Cape Town, University of Malawi and the University of Amsterdam.
Patient selection: pediatric patient from 2 months to 15 years of age
Parameter:
(1) hemoglobin in g/dL
(2) complications of anemia
(3) severe malnutrition (edema of both feet OR severe visible wasting)
Complications of anemia - one or more of the following:
(1) any respiratory distress (fast breathing, deep breathing, lower chest in-drawing, nasal flaring, grunting)
(2) cool extremities AND slow capillary refill time (>= 3 seconds)
(3) impaired consciousness
(4) prostration (if less than 1 year old unable to drink or breastfeed; if over 1 year old unable to sit unaided)
|
Hemoglobin |
Complications |
Severe Malnutrition |
Group |
|
< 4 g/dL |
NA |
No |
1 |
|
< 4 g/dL |
NA |
Yes |
2 |
|
4 to 6 g/dL |
Yes |
No |
3 |
|
4 to 6 g/dL |
No |
No |
4 |
|
4 to 6 g/dL |
NA |
Yes |
4 |
|
> 6 g/dL |
NA |
NA |
6 |
|
Group |
Blood Product |
Transfuse Over |
|
1 |
10 mL/kg packed RBCs, 20 mL/kg whole blood |
over 4 hours |
|
2 |
5 mL/kg packed RBCs, 10 mL/kg whole blood |
over 4 hours |
|
3 |
10 mL/kg packed RBCs, 20 mL/kg whole blood |
half in first hour, remainder over 2 hours |
|
4 |
decision to transfuse based on individual patient (see 2) |
over 4 hours if transfused |
|
5 |
not routinely transfused |
NA |
All patients with hemoglobin <= 6 g/dL were admitted and closely monitored.
A diuretic (furosemide) may be given if fluid overload an issue during blood transfusion.
Specialty: Clinical Laboratory, Surgery, general, Anesthesiology, Emergency Medicine, Critical Care
