ACH - Calgary Laboratory Services

ACH Pediatric Massive Transfusion Protocol (MTP)
Appropriate Initial Interventions
√ Intravenous / intraosseous access→ 2 access points
√ Crystalloid→ 3:1 ratio with EBL to max 50 mL/kg
√ Labs → T&S, CBC, coagulation, lytes & ionized Ca
√ Continuous monitoring → VS, acid/base, Intake/Output
√ Aggressive re-warming – including warmed RBC’s and plasma
√ Prevent/reverse acidosis
√ Correct hypocalcemia
→Ca gluconate 20 -50 mg/kg/dose IV slowly (1 ml/min)
√ Transfuse with unmatched RBCs on hand
√ Complete Tertiary Trauma survey if necessary
Other Considerations
√ Heparin reversal → Protamine 1 mg IV
per 100U of heparin
√ Warfarin reversal → Vitamin K 5 mg IV/IM
√ CRF & Von Willebrand’s
→ DDAVP 0.3 mcg/kg IV over 10 mins (max 20 mcg)
√ Consider antifibrinolytics:
→ Tranexamic acid 20 - 50 mg/kg IV load, then
10 mg/kg/hr (max total dose 100 mg/kg)
√ Intraoperative cell salvage
√ Consider rFVIIa (Niastase RT®) for persistent
coagulopathy in consultation with TM physician on call @
41367. See Niastase RT® Protocol for dosing information
√ Surgery
Identify & Manage Bleeding
√ Angiographic Embolization √ Endoscopy
Anticipate replacement of 50% of blood volume (40 mL/kg) in 3 hours OR
Estimated blood loss exceeding 0.5 mL/kg/min
MD ACTIVATES MTP
ASSIGN a clinical team member to activate MTP (MUST be a Nurse – not a Unit Clerk)
PHONE Transfusion Medicine (TM) at 52332
PROVIDE Patient name and sex, RHRN, weight, location, ordering physician
RECORD Name of TM technologist you are speaking with & fill out evaluation form
ARRANGE for pick up of pack (page STAT porter for expedited pick up at 04678)
Standard MTP Pack
√ 3U RBCs
√ 2U FFP
RBC’s
FFP
Platelets
THRESHOLD
DOSE
Aim for Hgb ≥ 100 in
bleeding coagulopathic
patient
Hgb ≥ 70 is sufficint in most
stable non-bleeding patients
If INR > 1.5
Give 10-15 mL/kg FFP
If < 50,000
Cryoprecipitate Fibrinogen less than 1g/L
OR evidence of
microvascular bleeding
Give 5-10 mL/kg
Platelets should drip freely
and not be transfused
using a warmer or
pressurized infuser.
Give 1U/5 kg
√ 1 dose Platelets
Or at clinician discretion
Q30 Minutes
General Pediatric Guidelines for Lab Based Blood
Component Replacement
PRODUCT
Collect Type &
Screen STAT
Hemostasis
& resolution of
coagulopathy?
Clinical Team
member calls TM at
52332 for another
MTP pack
No
MD can adjust pack
based on labs prn
Yes
Repeat CBC, INR, PTT
& fibrinogen q1h
Stop MTP
* Notify TM & return any
unused blood ASAP
* Resume standard
ordering in SCM
Repeat ABG, lytes,
ionized Ca, serum
magnesium q30min
NOTE: No order for MTP in
SCM
– At end of MTP, enter
Clinical Communication: MD to
Nurse order in SCM to include
all blood products transfused
during MTP
1 Massive Transfusion Definitions Replacement of 50% of blood volume in 3 hours (40 ml/kg) or blood loss > 2 ml/kg/min or replacement of a blood volume (80 ml/kg) in 24 hours.
2 Protocol based on varying levels of evidence and expert consensus. Developed in conjunction with the Alberta Children’s Hospital Pediatric Trauma Program and Transfusion Medicine
CLS form# TSO1304
20110613
DIRECT TELEPHONE DISCUSSION BETWEEN TRANSFUSING PHYSICIAN AND TRANSFUSION MEDICINE TECHNOLOGIST IS ENCOURAGED

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