Pediatric Blood Transfusion

There are several different components of the blood that can be transfused. Red blood cells are the most common type of transfusion. If a child's physician has decided your child might need a transfusion of blood, or blood products, he or she will explain the reasons for the transfusion. There are several reasons why a child may require a blood transfusion, including:

• An anticipated loss of blood during the surgery.
• A low blood count before, during or after surgery.
• Trauma or burns
• Diseases, such as leukemia⁽⁴⁾, kidney disease and sickle cell disease
• To replace an infant’s blood taken for laboratory tests.

Human blood is made of a fluid called plasma that carries red and white blood cells⁽⁵⁾ and platelets. Each part of blood has special functions and can be separated from each other. The parts are:

• Red blood cells carry oxygen from the lungs to other body organs and carry carbon dioxide back to the lungs. A certain number of these cells are needed for the body to function. Bleeding due to trauma, surgery or disease may cause a low red blood cell count.
• White blood cells fight infections by destroying bacteria, viruses and other germs. White blood cell transfusions are rarely given. They are usually reserved for children who have a low white cell count and severe infection that is not responsive to antibiotic therapy.
• Platelets help control bleeding by making clots in the blood vessels opened by injury or surgery. The body may not be able to make enough platelets because of bone marrow⁽⁶⁾ disorders, increased destruction of platelets or medications, such as chemotherapy⁽⁷⁾. Platelets may be transfused before a procedure that may cause a child with a low platelet count to bleed.
• Plasma carries the blood cells throughout the body and contains proteins and minerals. Some of the proteins help the blood to clot. Plasma or fresh frozen plasma can be transfused in children who have a severe deficiency of certain clotting components of the blood.

Blood is classified by the ABO and Rh systems. The ABO system includes A, B, AB and O blood groups. Each group of blood has a positive or negative Rh factor, or type. Each sample of donor blood is tested for blood group and type (ABO and Rh). Before transfusion, a sample of the donor blood is carefully tested with a sample of the patient's blood to determine if the two are compatible. According to the American Association of Blood Banks, distribution of the blood types in the United States is:

• O positive = 38%
• A positive = 34%
• B positive = 9%
• AB positive = 3%
• O negative = 7%
• A negative = 6%
• B negative = 2%
• AB negative = 1%

People with type O blood are considered universal donors because their blood can be given to people with any ABO type blood.

Another test, anti-HBc, is done to check that the donor blood is not contaminated with any form of hepatitis. Many viruses are now detected using special testing called nucleic acid testing (NAT). If any test is positive, the donor blood is destroyed. Other tests may be added to improve transfusion safety.In addition, because testing is not foolproof, investigational studies regarding the safety of blood and blood products are introduced often. As a result, patients and families may be informed in the future if blood or blood products have any risk of infection that was not appreciated at the time of transfusion.

The anti-HBc test is done to check that the donor blood is not contaminated with any form of hepatitis. Many viruses are now detected using special testing called nucleic acid testing (NAT). If any test is positive, the donor blood is destroyed. Other tests may be added to improve transfusion safety. In addition, because testing is not foolproof, investigational studies regarding the safety of blood and blood products are introduced often. As a result, patients and families may be informed in the future if blood or blood products have any risk of infection that was not appreciated at the time of transfusion.

Each sample of donor blood is tested for blood group and type (ABO and Rh). Before transfusion, a sample of the donor blood is carefully tested with a sample of the child’s blood to determine if the two are compatible.

Because the blood is so carefully tested there is a very low risk that an adverse reaction or side effect may occur. Adverse reactions may include a hemolytic reaction in which the transfused cells are destroyed, an allergic reaction in which itchy bumps called hives develop, and febrile reaction in which fever and chills may occur. Steps taken to avoid adverse reactions from a transfusion include:

• Double-checking the group and type of the blood before each transfusion. A medical technologist checks blood group and type before the blood is assigned to the child. In addition, the child’s nurse re-checks the blood before transfusion to be sure the child receives the proper blood.
• Treating allergic reactions with antihistamines. Two out of 100 hundred transfused patients may develop these reactions, but they are often mild and easily treated.
  educing the risk of febrile reactions by using special filters to remove white blood cells before blood is stored.
• Treating recurrent febrile reactions by giving medication before the transfusion.
• Adhering strictly to sterile procedures to avoid contamination of blood.
• Testing for diseases that can be transmitted by transfusion is performed on all donated blood. If any test is positive, the donated blood is destroyed. In order to further improve blood safety, new testing is occasionally added. As a result, patients and families may be informed in the future if blood or blood products have any risk of infection that was not appreciated at the time of transfusion.

Hepatitis is an inflammation of the liver that can be caused by a number of viruses. All blood products are screened for hepatitis type B and type C.

The risk of getting AIDS from a transfusion is now very small (1: 2,135,000). Most cases of AIDS attributed to transfusion came from untested blood transfused prior to 1985.

The first test to detect the antibody of the HIV virus was licensed in February 1985. It is not a test for AIDS, but for prior exposure to the HIV virus. Another test, HIV Antigen, was licensed in March 1996, to further assure blood safety. That test was replaced in May 2003 by a test for the actual virus using a method called Nucleic Acid Testing (NAT).

A few individuals may have HIV, but test negative. For this reason, federal law requires that individuals in high risk groups for being infected with AIDS (men who have had sex with men and intravenous drug users) must wait at least 3 months before giving blood. If an individual suspects they might have had intimate contact with a high risk person, they must wait one year before they give blood.

There are currently no substitutes for red blood cells. Alternatives to using blood include transfusing salt water (saline), or a protein called albumin. Depending on the kind of operation, age and size of the child, the child can give for him/herself (autologous donation) or blood lost in surgery can be harvested⁽⁸⁾ and infused. Parents may want to discuss these alternatives with their child’s pediatrician.

Children's National offers the Directed Donor Program, which allows a patient’s parents, family or friends to donate blood to be used during the patient’s hospital stay and/or for procedures. However, there is no scientific evidence that blood from one’s own family is "safer" than blood donated by volunteers. In addition, under certain circumstances, parents should not give blood for their child. A Children's National blood donor recruiter also can explain the procedures and policies for donating blood. Call 202-476-KIDS for more information.

Some children can give blood for themselves; this is called an autologous blood donation. The child must be healthy, cooperative, and not be anemic⁽⁹⁾. Small children can’t be their own donors. A child’s doctor can advise parents on whether their child can donate. There are additional administrative charges for this service.

Children’s National's Blood Donor Center collects blood donations. It is located in room 2302 on the second floor in the laboratory area. All donations are made by appointment by calling 202-476-KIDS.

Parents are urged to schedule their donors as far in advance as possible due to the limited number of appointments available per day. Blood products that pass all laboratory testing will be available for transfusion within three working days of donation.

Patients and families are not required to donate blood to replace what is used for the child. Blood is available for anyone who needs it, but it is important for everyone to help maintain the supply by sharing their good health by giving blood.

The cost of the processing, testing, storage and distribution of blood is passed on to patients. There is no charge for the blood itself. Check with your health insurance company to find out if these fees are covered.