In most cases, transfusions are a necessity in order for the child to complete treatment. The child receives blood transfusions for low hemoglobin (Hb) and low thrombocytes (trc).
Values vary with age. Generally, normal values for Hb in children are lower than in most adults and reach adult values around puberty.
- Acute blood loss > 15% of total blood volume
- Hb < 8.0 g/dl and symptom-causing chronic anemia
- Hb < 8.0 g/dl and reduced bone marrow function, Hb decreasing and without sign of regeneration
- Hb < 8.0 g/dl in perioperative period
- Hb < 7.0 g/dl in child without sign of other illness
- Ongoing bleeding and thrombocytopenia (trc. < 50 x 109)
- Decision is otherwise based on the degree of thrombocytopenia and its cause (production loss or increase of use)
Thrombocyte transfusion as prophylaxis:
- For counts < 5 x 109/l if the child does not have an increased tendency for bleeding from other cause or significant increase in use. The lower limit can be raised to < 10 x 109/l or < 20 x 109/l if a fall is still expected and thrombocytes cannot be obtained on short notice.
- For thrombocytes < 20 x 109/l after bone marrow transplantation or high febrile infection.
- Before invasive procedures:
- For spinal tap, thrombocytes should be > 20 x 109/l and
- Puncture biopsies (liver/kidney/tumor) > 50 x 109/l
- For surgery, thrombocytes should be > 50–100 x 109/l (insertion of central venous catheter etc.) depending on the character of the procedure and whether there is a tendency for bleeding from other causes. After surgery, thrombocytes should be checked and transfusion should be repeated the same day if needed.
- The child is able to complete treatment
- Maintain intravascular fluid volume to ensure blood flow to all vital organs
- Maintain sufficient oxygen transport to peripheral tissue