Parents | Pediatric Transfusion

Blood transfusions are provided to primarily replace one or more blood components in the body. Most commonly red blood cells are transfused.

Human blood is a fluid mainly consisting of plasma which carries red and white blood cells and platelets. All the cells have very specific functions.

Red blood cells: These are the cells with the primary responsibility of transporting oxygen from the lungs to all the parts of the body as well as carrying carbon dioxide from all the organs back to the lungs. Transfusion of red cells may be required in cases of bleeding, surgery or a disease state causing low red cells in the body.
White blood cells: These are the cells with the primary function to fight infections and guard our body. These cells destroy bacteria, viruses and other germs. White blood cell transfusions (mainly granulocyte transfusions) are given in very specific conditions. They are usually transfused in cases where neutrophil counts are low and the patient has having severe infection which is non-responsive to antibiotics.
Platelets: These are the cells with the primary function of controlling bleeding and making clots where there is injury to the blood vessel. There is a need to transfuse platelets when the body is not able to make these cells (in bone marrow) or when the patient is on a drug which can inhibit its production (like chemotherapy).
Plasma: This is the fluid which carries the blood cells throughout the body. This fluid contains very specific proteins and minerals which are essential for the proper functioning of various organs of the body. Plasma or fresh frozen plasma in children who have severe deficiency of these proteins such as clotting factors.

The blood is broadly classified based on various blood groups. These blood groups have specific structures present on the surface of the red blood cells. For routine clinical transfusion practices, there are two major blood groups such as ABO and Rh blood group systems. ABO system included A, B, AB and O blood groups. Each blood group may be positive or negative for Rh factor (D antigen).
As per the laws of genetics if any individual possesses an antigen, then they do not possess the antibody against that antigen. E.g. A blood group individual will have an Anti-B antibody and not Anti-A. Based on this principle O blood group individuals are considered as universal red cell donors as they do not have any antigen.

Patients/ Recipients Blood Group	Compatible Donor Blood Groups
Patients/ Recipients Blood Group	Packed Red Blood Cells	Platelets	Plasma	Cryoprecipitate
O Positive	O Positive O Negative	Rh positives/ negatives; O preferred	Any group	Any group
O Negative	O Negative	Rh negatives; O preferred	Any group	Any group
A Positive	A Positive A Negative O Positive O Negative	Rh positives/ negatives; A preferred	A, AB	Any group
A Negative	A Negative O Negative	Rh negatives; A preferred	A, AB	Any group
B Positive	B Positive B Negative O Positive O Negative	Rh positives/ negatives; B preferred	B, AB	Any group
B Negative	B Negative O Negative	Rh negatives; B preferred	B, AB	Any group
AB Positive	Any group; Positive/Negative	Rh positives/ negatives; AB preferred	AB	Any group
AB Negative	Any group; Negative	Rh negatives; AB preferred	AB	Any group

As per the regulations by the Government of India, each blood unit transfused should be screened for transfusion-transmitted infections (TTI) such as HIV1/2, Hepatitis B, Hepatitis C, Malaria and Syphilis.
All these tests should be done by government-approved serology platforms/ techniques such as ELISA or Chemiluminescence. These platforms screen for the antigen of the pathogen and/or antibody against the pathogen.
Most advanced nucleic acid testing (NAT) is also used to screen for viruses such as HIV, Hepatitis B and Hepatitis C. In India, screening of blood with NAT technology is used as an additional layer of safety above the mandatory serology techniques.
Few countries may test for more pathogens depending on the prevalence of TTI in their region.

The sample from the child is received in the blood centre and a complete ABO and Rh blood grouping is done. A similar blood group blood component is selected as per the clinical indication and need. The blood component is crossmatched/ matched with the child's blood sample. If found compatible then the unit is issued as per the need.
In case any incompatibility is encountered, further testing is done and compatible units are arranged and provided to the patient.
At some higher centres, all the patient's samples are screened for the presence of a rare antibody against the rare blood groups.
In the case of newborns (age less than 4 months), the mother's sample is used for crossmatching and the red cell unit compatible with the mother may be issued to the patients. This is considered as a newborn is not capable of producing an antibody at that age and the antibody present in his/her circulation is derived from the mother.

There are currently no substitutes for red blood cells. Alternatives to using blood include transfusing salt water (saline), or a protein called albumin.

As per the policy the blood centre at PGICH, Noida does not recommend the use of parental blood for their child as it poses a risk of immunological reactions which may be harmful (Transfusion-associated graft versus host disease) for the child.

Some children depending on their age, weight and disease condition can donate for themselves. (Autologous blood donations) Although this is not a common practice for pediatric age group of patients.

Since the blood units are carefully tested and screened there is a very low risk of any adverse reaction or event. Some of the rarely reported events are hemolytic transfusion reactions, allergic reactions and febrile reactions. There are some steps taken to avoid these reactions such as

Verifying the identity of the sample and the patients to avoid wrong transfusions.
Using some premedication to manage an expected reaction (used in cases where there is history of transfusion reactions).
Adhering to the sterile and aseptic process of transfusions.

Children receive blood volume based on their weight. They receive 10-15 ml/kg depending on their clinical condition.
As per Government regulations, any donor can donate either 350 ml or 450 ml of whole blood depending on their weight. Collection of lesser volume or customized volume is not allowed.
Donating one complete unit can help your child receive all types of blood components as well as may help some other children admitted to the hospital.

A newborn child does not produce any antibodies at birth. All the antibodies present in the newborn baby are derived from his/ her mother. Therefor the blood group of the component issued from the blood centre may be different from the original blood group of the child.
This policy is followed up till the age of 4 months of the newborn.