Blood transfusion in pediatrics part1

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DR MURUGESANDR PRAMOD SARWA

Blood transfusion

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OVERVIEW HISTORICAL BACKGROUND BLOOD COMPONENTS types available properties indication PEDIATRIC CONSIDERATION physiological TRASFUSION GUIDELINES COMPLICATIONS AND MANAGEMENT

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SEGREGATION OF BLOOD PRODUCT Whole blood ….. Pc Platelet rich plasma …. Platelet Platelete poor plasma ….ffp…cryo …f

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What is different……..

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Oxygen delivery

DaO2 =Cardiac output X CaO2 [oxygen content]

Oxygen content[Hb saturation X 1.34 X Hb conc] + 0.003 X PO2Amount of oxygen carried by 100 ml of blood

Fetal hemoglobin

Cardiac reserve Increased metabolism

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Fetal hemoglobin

HbF – 70-80% of full term and 97% of premature infants’ total hemoglobin at birth

Fetal hemoglobin

Shorter life span of 90 days (HbA- 120 days)

HbF interacts poorly with 2,3,DPG P50 with HbF is 19 mmHg P50 with HbA is 27 mmHg

Leftward shift of ODC

ODC

Hemoglobin for equivalent oxygen delivery

P 50 Hb

Adult 27 10

Infants [>3 month]

30 8.2

Infants [<3 month]

24 14.7

Motoyama et al. 1990

6 months- 6 years12

7-13 years 136 months- 6 years 127- 13 years 13

Preoperative hemoglobin

Term infant with Hb < 9 g/dl Preterm infant <7 g/dl

Haemoglobin levels that are adequate for the older patients may be suboptimal in the younger infant

Fetal hemoglobin

Cardiac reserve Increased metabolism

Adult vs children - cardiac reserve

• Children have a higher cardiac output to blood volume ratio than adults

Estimated circulating blood volumeAge Blood volume

(ml/kg)Premature infant 90-100Term infant – 3 months 80-90Children older than 3 months 70Very obese children 65

Sandra et al. Pediatric anesthesia 2005