Blood Component

1
Blood Component Therapy In Pediatric Oncology
Practice
INTP - PPO, PHO, IAP. SS B - 14 Slides
2

• BONE MARROW COMPROMISE
• Disease / Treatment
• TRANSFUSION REQUIREMENTS
• Malignancy
• Stage of disease
• Intensity of Chemo Rx
• Phase of therapy

INTP - PPO, PHO, IAP. SS B 2/14
3
Anemia in cancer

• BM replacement
• BM aplasia
• EPO deficiency/inhibitors
• Blood loss
• Rate of decline of Hb

INTP - PPO, PHO, IAP. SS B 3/14
4
When To Transfuse ?

• Hb less than 7 gm/dI
• Symptomatic anemia
• Raise Hb to 10 - 11 gm/dI

INTP - PPO, PHO, IAP. SS B - 4/14
5
Hb 7 -10 Gm/dl Transfuse If

• Marrow recovery not imminent
• Subsequent intensive chemo with
• predictable marrow hypoplasia
• Bleeding
• Febrile neutropenia
• - severe LRTI/sepsis

INTP - PPO, PHO, IAP. SS B 5/14
6
How To Transfuse ?

• Packed cells /Whole blood
• 15ml/kg should raise Hb by 2.5 gm/dl
• Smaller volumes if
• - Hb less than 5 gm/dI
• - Hemodynamic compromise
• Partial exchange
• - Hyperleucocytosis

INTP - PPO, PHO, IAP. SS B 6/14
7
??

• Saline washed cells
• Leucocyte filters
• Irradiated

INTP - PPO, PHO, IAP. SS B 7/14
8
Platelet Transfusion

• Thrombocytopenia
• Potentially life threatening
• Risk of bleed proportional to platelet
• count
• Leukemia / Chemo Rx
• Concurrent infection

INTP - PPO, PHO, IAP. SS B 8/14
9
When To Transfuse Platelets ?

• Active bleeding
• Plat ct lt 5000
• - severe neutropenic infection
• Plat ct lt 20,000
• - before minor Sx
• Plat ct lt 50,000
• - before major Sx.
• BM aspiration /LP X

INTP - PPO, PHO, IAP. SS B 9/14
10
What Platelets To Transfuse ?

• ABO / Rh
• - Matched / Mismatched
• Rh -ve patient
• (Rh - / Rh with anti D globulin)
• Shelf life 5 days
• Random v/s Single donor

INTP - PPO, PHO, IAP. SS B 10/14
11
How To Transfuse Platelets ?

• Rapid Tx over 1/2 - 1 hr
• 1-2 u/kg body wt
• Every 24 hr till bleeding stops
• More freq if DIC / infection
• Efficacy cessation of bleed

INTP - PPO, PHO, IAP. SS B 11/14
12
Adverse Reactions

• Febrile rxn
• Allergic rxn
• Hemolytic rxn

INTP - PPO, PHO, IAP. SS B 12/14
13
Adverse Reactions
Metabolic Delayed Hypocalcemia Alloimmunisati
on Hyperkalemia TTD - HBV, HCV
HIV GVHD
INTP - PPO, PHO, IAP. SS B 13/14
14
Coagulopathy

• DIC
• Hepatic dysfunction
• Vit. K deficiency
• L-asparaginase
• FFP 10ml/kg IV over 1 hour
• Rpt 8-12 hourly

INTP - PPO, PHO, IAP. SS B 14/14