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Weight-based pediatric blood orders


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We're in the process of building weight based pediatric red cell orders at my hospital . Once the patient reaches a certain weight it will only allow them to order full units instead of the partials aliquots.

We stock the transfer packs that go up to 300 mL, but do not routinely make aliquots larger than 270mL. Our inventory is mostly whole blood derived (doesn't state the actual volume of the bag), and based on my estimate calculations ranges in volume from 300 mL to 378 mL (very fat bag). The average was about 325 mL.

How do you handle the pediatric patients that fall in that middle ground between 270 and a full unit? Do you routinely aliquot to the full 300 mL transfer pack and the doctor just deals with the extra?

Ideally the nurses would just take the full unit and transfuse to the desired amount based on rate, but we have multiple instances of them failing to do so which is why we're building new order sets. .

Our peds doc seems to be ok with some extra but wants us to never give more than a X mL unit when transfusing full units to peds patients (still deciding what is acceptable for X). 

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  • 2 weeks later...

Am I missing something? I always understood that the use of transfer packs or syringes was to minimize waste, i.e. several transfusions from one RBC. This seems like a lot of extra work in the BB just to make life easier for the nurses.

On a practical note it may be easier for you to determine X as a max weight for an RBC unit. See if the ped docs are OK with your average unit and use that weight. So an RBC less than X can be chosen, it's weight entered in LISS, then XM and issue as normal.

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  • 2 years later...

The average amount of blood in the red cell units we receive is 350 ml, ranges from 300 to 400(seldom seen). If the order is over 270 we select the smallest unit we can find( weigh it) and give the whole thing to the nurse, instructing them to transfuse the amount desired and discard the remainder. They use a pump so can measure the amount to transfuse. And it would be a rare occasion that we would use the remainder of that bag on someone else because  we really aren't a "one and done" transfusion service and would end up starting another unit which would  mean another exposure so we try not to do that

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I agree with slsmith, we weigh each bag and write the volume on the unit or the transfusion record (we're still using paper).  We don't have a set age where they can't order by volume so on some kids we end up doing a full unit plus a partial unit.  For example if they order 425mL we give 1 full RBC that's 310mL + a partial that's 115mL.  

As far as setting infusion guidelines our standard is 1-2 units cryo per 10kg as fast as tolerated, 10-30mL/kg for FFP at a rate indicated by clinical situation (normally as fast as tolerate), 10 ml/kg RBC at a rate of 2-5mL/kg/hr or as ordered by physician, 5-10 mL/kg Platelets (we only use apheresis not WBD) as fast as tolerated and 10 mL/kg granulocytes over 4 hours.

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