PEDIATRIC MASSIVE TRANSFUSION PROTOCOL

[MAGNUM]

Although we are technically not a pediatric transfusion service, other than NICU patients, we have recently received pediatric trauma patients that could have needed blood.  Would anyone be willing to share their processes and policies for pediatric MTP's?

thanks. 

Scott

[Mabel Adams]

I tried hard a few years ago to find evidence for this but found nearly nothing in terms of evidence-based guidelines.  I will try to add here what I came up with, but it is fairly arbitrary.  It is part of our MTP document.  It loses a lot of formatting here.  Sorry.  Broselow Tape is used in ED to estimate the size of a child.  Maybe see if your ED can share what this looks like.  This information is intended to be of practical use as a loose guideline for the poor blood banker working on the unusual day that we get a pediatric hemorrhage in.  I am very open to improvements.   Good luck!

Broselow Tape Patient Size Correlation:

	Grey 3-5 kg	Pink 6-7 kg	Red 8-9 kg	Purple 10-11 kg	Yellow 12-14 kg	White 15-18 kg	Blue 19-23 kg	Orange 24-29 kg	Green 30-36 kg
Wt. in Lbs.	7-11	13-15	18-20	22-24	26-31	33-40	42-51	53-64	66-79
Approx age	< 3 mo.	3-9 mo.	4-15 mo.	1-2 yr.	2-3 yr.	4-5 yr.	6-7 yr.	8-9 yr.	10-11 yr.

 1 unit Platelet order at SCHS = 1 apheresis platelet = 6 units of whole-blood-derived platelet (6 pack)

• Product = any and all types of blood component therapy, to include RBC, plasma, platelets, and cryoprecipitate.
• Bend only: Group A plasma may be used as universal donor plasma for adults and children over about age 5.

Blood Products	Grey 3-5 kg	Pink 6-7 kg	Red 8-9 kg	Purple 10-11 kg	Yellow 12-14 kg	White 15-18 kg	Blue 19-23 kg	Orange 24-29 kg	Green 30-36 kg	Adult
MTP Round 1	10 ml/kg is ~equivalent to 1 unit RBCs to an adult.
Red Cells	1 unit *	1 unit *	1 unit	1 units	1 units	2 units	3 units	3 units	4 units	4 units
Plasma	1 unit †	1 unit †	1 unit †	1 unit †	1 unit †	2 units †	2 units	2 units	2 units	2 units
Platelets	‡	‡	‡	‡	‡
Cryoprecipitate	1 single cryo as ordered or if Fib <100	1 single cryo as ordered or if Fib <100	1 single cryo as ordered or if Fib <100	1 single cryo as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100
MTP Round 2	Repeat Round 1	Repeat Round 1	Repeat Round 1	Repeat Round 1	Repeat Round 1
Red Cells	1 unit *	1 unit *	1 unit *	1 units	1 units	2 units	3 units	3 units	4 units	4 units
Plasma	1 unit †	1 unit †	1 unit †	1 unit †	1 unit †	2 units †	3 units	3 units	4 units	4 units
Platelets	‡	‡	‡	‡	‡	1	1	1	1	1
Cryoprecipitate	1 single cryo as ordered or if Fib <100	1 single cryo as ordered or if Fib <100	1 single cryo as ordered or if Fib <100	1 single cryo as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100
MTP Round 3	Repeat Round 1	Repeat Round 1	Repeat Round 1	Repeat Round 1	Repeat Round 1
Red Cells						2 units	3 units	3 units	4 units	4 units
Plasma						2 units †	3 units	3 units	4 units	4 units
Platelets
Cryoprecipitate						1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100	1 pool of 5 as ordered or if Fib <100
Continuing Rounds						Repeat Rounds 2 & 3	Repeat Rounds 2 & 3	Repeat Rounds 2 & 3	Repeat Rounds 2 & 3	Repeat Rounds 2 & 3

* If < 4 months old (grey & pink)

·         Irradiated blood & platelets not required unless specifically ordered by physician.

·         Continue to give only O RBCs & AB plasma regardless of baby’s blood type.

·         Unless AB platelets are available or they request otherwise, wait to give ABO-incompatible platelets until the baby has had a partial transfusion of O RBCs to reduce ABO incompatibility.  Avoid giving O platelets on a non-O baby.

·         Syringes with filters issued with RBCs and platelets in case preferred over blood administration set.

·         Still must use blood warmer for massive transfusion if syringes used.

·         All blood products must be filtered, either by blood administration set or syringe with filter.

† Thaw AB plasma as universal donor on all peds under ~18 kg (40 lbs.—around age 5). Don’t use A plasma for them as universal donor without physician/pathologist approval.

‡ Issue platelets with instructions to give only part of the unit or run it as needed over 4 hours (or can aliquot if time).  These are the fractions of a unit proportional to the RBCs being given in each round. Communicate this information to nurse.

Grey 3-5 kg	Pink 6-7 kg	Red 8-9 kg	Purple 10-11 kg	Yellow 12-14 kg
1/5	1/5	1/3	1/3	1

This policy does not apply to exchange transfusions of neonates.

 

 

[Baby Banker]

The Pediatric Trauma Society used to have some examples on their website.  I'm not a member any longer, so I can' check to see if they are still there.

https://pediatrictraumasociety.org/

 

[AMcCord]

We used to have a weight based formula but recently switched to sending the same cooler of products regardless of patient age/size. For kids the red cells would be O neg and AB liquid plasma. It is up to the surgeon/pediatrician to determine what and how much is transfused. We just make sure they have plenty of what they need. Any unused product comes back in the cooler and is returned to inventory.

We receive very few pediatric trauma cases that need blood products over the course of a year so we (Blood Bank and our Medical Director plus Trauma Coordinator, with pediatric consult) decided to keep things simple on our end and let the medical folks do what they need to do. It's hard for us to get timely basic info in a trauma situation - male/female, kid/adult - much less weight. Using the one size fits all response instead of pulling a chart to check for specific requirements minimizes confusion for our generalists who may only have to respond to MTP orders a couple times a year. It keeps our TAT for cooler delivery fast and doctors happier. We aim for <10 minutes and our median time is 6 minutes over the last 2 years, regardless of where the cooler needs to go. 

[sgoertzen]

I've attached our MTP procedure and worksheet.  We are a children's hospital with a level 2 pediatric trauma center.Massive Transfusion Protocol - MTP.pdfMassive Transfusion Protocol - MTP Worksheet.docx.pdf