Aims Review efficiency and adequacy of blood and platelet transfusions in paediatric malignancy and haemoglobinopathy patients, based on recommendations from BCSH 2009, UK standards for children with thalassemia 2008 and local trust guidance.
Methods We retrospectively reviewed 80 blood and platelet transfusions in 10 children during August 2011- June 2012. 60 occurred in 7 children with malignancy (34 Red cell and 26 Platelets), and 20 red cell transfusions in 3 children with beta thalassemia major. We used as thresholds, a low Hb. 8g%, maximum Hb. of 12g% and a correction factor of 3; for platelets, counts of 20–30 or as specified ie >50 post neurosurgery, or >75 for LP; and for thalassemia Hb. >9g%. We also used as an estimate volume in a Red cell unit as 270mls and platelet unit as 180mls, unless specified.
Results Appropriate in time:
Thalassemia: 20/20 Red cell transfusions were all elective and in routine hours.
Haem-Onc.: 40/60 were elective of which 34/40 occurred in routine hours. 18/60 were “pragmatic” ie. in anticipation of chemo, procedures, sepsis, discharge etc., of which 7/18 occurred in routine hours. 2/60 were urgent transfusions, occurred in routine hours.
Appropriate in amount:
The weights across all 10 patients ranged from 8 – 49kg.
Conclusions 85% elective and 40% pragmatic transfusions occurred in routine hours. Pre transfusion thresholds and volume of transfusions in all 3 groups were acceptable. The variation in prescribed volumes reflects minimising exposure and wastage by prescribing in units wherever possible. These correlations are best visualised on the attached slides.