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TRANSFUSIONS

IN

PEDIATRIC
PRACTICE:
AND LIMITATIONS
By

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vious

anemia

who,

single

blood

the

at

irregular

transfusion

and

nocytes

lesser

amounts

cannot

tenial

rise

blood

is

be

in

blood
volume
than
to whom
similar
Hence,

in

of donor
necessary
raise

blood

which

the

to

in the
amounts

determining

in

smaller
may
the

rate

several

transfusions

period

values
rate

short

to

normal

of decline

may

blood

yond

the

sideration

of many

a ma-

of

of

syndromes
In

apply

more

1.

Restore

from

in Premature

Restore

In
followed
healthy

most

clinics
with

regard

premature

when

a conservative
to transfusions
infant.
At the

4 to

7 weeks,

the

adult
low

hemoglobin
values
levels,
spontaneous

infants

policy

is

in the
age
of
fetal

and

have
decreased
to
recovery
usually

Supply

4.

Miscellaneous:

specific

conand

the

physiindications

treatment

of

II
TRANSFUSION

and

erythrocytes:

loss

and acquired

formation

trauma

coagulation

Infections
Hypoproteinemia
Exchange

such

volume:

burns,

3.

blood

data.
is be-

postoperative

blood

Shock,

in

disturbed

anemias-congenital

blood

in

part

because

to

FOR

chronic

listed
in

entities

practice

to

a detailed

hematologic

of hemoglobin

and

Defective

Infants

paper

embrace

frequently

Hemolytic

be estimated.

with

of background
of each
item

pediatric

deficit

Acute

not

transfusion
dealt

TABLE

to

in amounts

involving

ology.

alone.

enythnocytes

TRANSFUSION

INDICATIONS

are

of anemia

FOR

of this

eryth-

have
need

weight.

been

scope

We
rarely

packed

for

have

Pre- and
Transfusions

to

approxi-

body

indications
II

would

levels

basis

is given

elaboration

as

been

reticulo-

weight.
infants

the foregoing
analysis
Complete
elaboration

higher

so

of

without

gain

either

10 mi/kg.

of survival

blood,

6 and
hemoglobin

levels

ml.

the

on

individual
be given.

within

has

whose

to

whole

amount

diluted

between

at

premature

required,

The

be obchronic

show

failure

that

Table

receives

This

hemoglobin.

necessarily

hemo-

hemorrhage

of packed

those

INDICATIONS

on

of

to

persist

and

When

and

ml.

expected

ness

exceed

500

the

marrow

as disclosed

practice

7 to 8 gm./100

on whole

periods,

of

bone
trend,

own

only

volume

It should
with

child

olden

present

Our

transfusions

within

as

is to run

inherent

decreased

ml.

increas-

of

improvement.

that

have

With

such

cessation

The

found

depend-

depending

therapy,

elevation,

and

significance,

point

un-

complica-

recent
survey50
is to transfuse
only
premature
infants
whose
hemoglobin

blood

substituted

this

seems

cytosis.
Transfusion
is employed
when
there
are evidences
of infection,
anorexia,
listlessto

but

known

trans-

negenera-

hand

the
at

ti9

at

of

of

normal

is

transfuse

depressing

mately

packed

degree
anemia

their

to

concentrations

and

calculated

volume.

lose

are

blood

when

Besides

of

synthesis

Administration

a time

necessary.

in a
those

predominant

hemoglobin

gm./100

I serve

and

expanding

objectives

globin

of the

at
of

values

transfusion.

are

in varying

risk

suffi-

concentration

of blood

these

of

values

count

tions,

in-

hema-

the
type.1

transfuse

blood

severity

ad-

cent.

in a single

hemoglobin

enythrocyte

total

in Table

amount

the

the

of

final

with

fusions
tion

the

PRACTICE

adult

and
in

been

addition

the

whole

begins

supplementary

prescribed

plasma

elevate

the

PEDIATRIC

the

the mean
hemis reduced
to

to 50 per

dosages

the

have
a

cells

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The
as

with

and

Rh

of

the latter.
differences

combining

In that manner
Rh positive
cells

cent

cient

amount

in

and donor,
of erythrocytes

acid-citrate-dextrose
by

the

removed
for instance,

IN

in erythroblastosis

Poisoning

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factors

including

platelets

AMERICAN
blood

disorders,

deficiency

infection,

states.

ation

in

the

transfusion

for

instance,
not

young

achieved
task

because

the

but

is subject

pretation.
The complexities
transfusion

many
aid

transfusion

portant

is the
blood.

Yet,

as

as

are

be

the

concerns

the

disease:

during

exchange

charge,

and

mately

S months

facilities

now

to

use

for

performing

the

higher
by

exchange

tary

to

course
12 gm./100

of

3,000,000

with
ml.
to

the

is an

below

indication

packed
globin

process

ml.
the
With

prior

a single

in
the

the

first

knowledge

now

The
philia

in-

transfusion
the

12 to

weeks
that

after
Rh

hemo-

onset

the

reveal

nism.

in

into

von

2 types:

defect,

and,

in

common
with

of antihemo-

majority

of these

infancy

and

is usually

initial

and

the

the

and

a reduction
function

of

investigated.

conditions
whether

to

nature

thoroughly

a
the

simple

pathogenesis

of platelets,
or

Although

Downloaded from by guest on October 23, 2016

these

of

to

di-

supervise

the

defect

For

history,

few

dis-

childhood,

expected

studies,

after

been

vascular

pen-

as

pseudohemo-

another
more
in combination

of the

pediatrician

rect

on

on

of deficiency

occurs

examination
of

discharge.

antibody

degrees

bleeding

14 grn./100

classified

globulin.

As the

has

of FTC
globulin.11

deficiency

subdivided

experience,12
which
occurs

orders

the

Ten

of hemophilia

to a vascular

treatment
of

the development
which
occasionally

been

fac-

prothnombin

antihemophilic
condition

has

(labile

for

cases

to

of

ante-

syndrome

varying

genera-

developments.
of

ascribed

restricted

philic

clotting

component

factor)

cent

bleeding

With

appro-

thromboplastin

recent

pen

spe-

and
The

factors

(stable

than

Willebrands

to discharge

Raising

approximately

at this time
offsets
extremely
low levels

occur

are

when

is more

of

heretofore,

thromboplastin

and

are

twenty

has

dealing
their
in-

defects
described

plasma

VII

to

type

erythrocytes.
to

(PTA),

hemoglobin
levels
of 10
and enythnocytic
counts

range
for

and
and

hemo-

application

advised.

for

newly

knowledge

thromboplastin

(PTC)

rather

others,

been

required

cedent

our

hemolytic

have

plasma

one

of

the

treatment

defi-

and

maintaining

expansion

With

conversion

pursue

in

hemor-

to a clearer

of established

procedures,

dis-

indication

In

role

of the

led

factors

cialized

infants

innate

THERAPY
IN
DISORDERS

have

This

ton)

1 supplemen-

3,500,000/mm.3.

this

of the

fol-

tense,
a second
exchange
transfusion
and/or
several
supportive
transfusions
are necessary to reach
these
levels.
In any event,
any
decline

nition

factors

technical

factors.

and

when

investigations

disorders

tion,

justifiable

an

intensive

rhagic

pniate

approxi-

the

related

of life,

TRANSFUSION
HEMORRHAGIC

unknown

of

to

is

transfusions

some

benign

prior

infant
it seems

other

transfusion

in whom

stay

transfusion

progress.

hemoglobin
particularly

tegration.

value

hospital

as

6 weeks

when
ml.

Transfu-

ex-

less

the

values

first
is in

age.

im-

treatment.
though
stages

exchange

supported

for

With

the

appears

of

created
a complexity
in concepts
with
the steps
of coagulation
and

values

various

of age.

months

stasis.

15 gm./100

hemoglobin

available,

evaluation

discovered

of

the

the

after

birth,

Alfor

clinics,

transfusion,
until

follow-up

following

are
unnecessary
exceed
8 gm./100

The

informamost

as

opinion,

in

sions
values

weeks

the

concentration

of

until

is

in

the

various

least

periodic

inter-

of

indication

maintained

lowing

an

in

diversity

important,

of

at

necessary

or

value

a decision

12 to as high

considered

A similar
to

at

for

synthesis

a uniform

sources

hemoglobin

from

ml.

optimal

one

cord

low

infant

erythroblastosis.

arriving

change

601

PEDIATRICS

transfusion

the

exemplified

of
related

in

in

level,

to individual

are

treatment

though

the

in relaand de-

of establishing

routine

modern

requires

by

a simple

child
fixed

tion

child

OF
sists

situof

a hemoglobin

to be
be

the

management

of abnormality
stage
of growth

Prescribing

may

and

to

the
in the

appraisal
a specific

velopment.

nutritional

contrast

adult,

needs

additional
tion
to

not

In

ACADEMY

most

physical
tests
is

will
based

abnormality

the

clotting

hemorrhagic

of
mechadis-

SMITH

602

TRANSFUSIONS

TABLE
TRANSFUSION

IN

PEDiATRIC

PRACTICE

III

THERAPY

IN

TABLE

THE

HEMORRhAGIC

LIMITATIONS

AND

IV

HAZARDS

OF

BLOOD

TRANSFUSIONS

DISORDERS
1.

A. Fresh

whole

blood

or

plasma:

Thrombocytopenic

purpura

Ilelnophilia
(hemophilia
A, AuG deficiency)
Parahemophilia
(factor V deficieiwy)
Von Willebrands
disease
I

Vascular

defect

only

(pseudoheinophilia)

with

AHG

Vascular
defect
hemophilia)
Afibrinogenemia
2.

VII

deficiency

A.
B.
C.

(vascular
4.
5.

deficiency

(stable

of

3. Trahislnission

B. Fresh or stored
whole blood or plasma:
Prothrombin
deficiency
IyrC deficiency
(hemophilia
B, Christmas
PTA deficiency
Factor

Development

factor)

to

are

the

classified

of hematopoiesis

7. Miscellahwous:
Febrile

requirements

whole

blood

category

for
benefit

purpura,
and

quent

reactions

induce

to

effects

as

in

thrombo-

hemophilia,

blood

formation

of

antihemophilic
thus
counteracting

ing

antibodies

yet
to

or to
benefi-

of untoward
greater
measure
tion

reactions
of safety

of transfusions.

hazards
mon

listed
the

are

hepatitis,

Table

limitations

IV,

the

hemolytic

allergic

and

reactions,
febrile

circulatory

overload.

been
made
icterogenic

in the direction
properties
of

reduction
violet
pooled

of
irradiation,

and

plasma

for

room
temperature.11
sensitization
from
been
markedly
screening
and

size

the

reduced
cross-matching,

have

of reducing
plasma
such
the

pool,

storage

prolonged
The
blood

and

advances

of

by

the
as

ultraat
of isohas

preliminary
refinements

before

in several

studies.1417

to

In

explain

produce

an

from

the

that

thesis

intervals

erythrocyte

retard

formation.

based

on

an

group

of

children

ranean
anemia
be interrupted

in

with

hemo-

absence
of
sets of obdocument

administered

at

hemoglobin
study

in whom
following

Downloaded from by guest on October 23, 2016

the
Two

These

intensive

influ-

rise
in

laboratory18

transfusions

multiple

of transfusion

anticipated

our

of

transmajor

limiting

failure

globin
and enythrocytes
hemolysis
or hemorrhage.
servations

case

this

the

may

a single
by the

the

however,

may

of

confirmed

of hematopoiesis

effects.

transfusions,

advent

been

in minor
degree
accompany
fusion,
it is overshadowed
corrective

inhibitreatment

the

has

as

erythThat

secondary
in the

and

retardation

has
potential

endogenous
synthesis.

this

anemia

transfusion
which

is its

recognized

therapy

frequent

of liquid
periods

incidence
transfusion

was

recently

ence

serum

reactions,

Many

the

corn-

of
and

attention

possess

effect

of incneasfactors.

limitations

effects
upon
and
hemoglobin

While

and

most

blood

comment

transfusions

more
a

identification

scant

depressant
ropoiesis

investigation

the

blood

rare

the

received

specific

have
provided
in the administra-

Of

in

of

of pernicious

LIMITATIONS
AND HAZARDS
OF TRANSFUSIONS
and

of

deserves

tory

experience

infected

and

numbers

which

of treatment.

Increased

toxicity

One
fre-

or plasma

globulin
the

from

Potassium

of techniques

vascular
too

of whole

the

platelets,
fibninogen,

whole
that

reactions

Reactions

Cold agglutinins
Air embolism
Citric acid intoxication

either

fresh

afibninogenemia,

transfusions

may

cial

from

disorders

hemophilia

stored

in

to emphasize

hemorrhagic

cytopenic

or

patients

It is important

such

according

fresh

on plasma,

would

blood.

III

jaundice

Malaria

Suppression

6.

serum

Syphilis

Circulatory
overload
Excessive
iron deposition:
A. Hemosiderosis
B. Exogenous
hemuochromatosis

factor)

in Table

isoimmunization

of disease:

homologous

Allergic

orders

intra-group

Ilemolytic
reactions:
A. Incompatible
blood
B. Old stored
blood

and
data

of

severe
transfusions
splenectomy.

are
small

Meditercould
By

AMERICAN
methods

designed

differentiation
blood
and

to

mass

it was

a retarding

and

marked

from

the

been

entirely

circulation

were

restored

in the

The

depressant
substantiated

the

Paralleling

cent

report1#{176} that
anemia
of

occurred

do

conclusions

fusing

nate

from
with

the

bone

periods

of

fene

with

bone

In

a persistent

blood

levels.
for

effort

less

dividualized
anemias

but

requiring

spacing

and

to

examination

be

not
in

frequent
size

of

and

other

appraisal.

require

in-

trans-

sugresult

disease
and

prescribed

quently

serves

vantage

than

globin

the

patient

maintaining

levels

by

frequent

of

blood.

and

effect
in

and

is indicated

for

tendant
promise

effect

is
ane-

chronic
transfu-

on

synthesis.

the

management
phase
of
of

patients

but
erythro-

The

must

re-

also

of the
erythroblastosis

be

con-

prematurity.

that
which
who

administrations
fixed
but

clinical
signs
of relief
by

ad-

in hemosiderosis

It should
be emphasized
globin
concentration
at
on multiple
be arbitrarily

maximal
restriction

multiple

transfusion

anemia

ad-

hemo-

refractory

of

anemic
the

the

suppressive

and

in

and
This

Here

alone

fne-

greater

normal

in

groups.

considered

to

hold-

the hemotransfusion

require

of blood
varies
with

single

cannot
the at-

and symptoms
and the
this form of treatment.

the
inin

REFERENCES

neconThe

constant

be

hemorrhage,

valescent

of

more

transfusions.

transfusions

attained

but

critical

alone

can

requirements

dis-

character-

to a minimum

blood

of trans-

normal

and

of

bleeding

ing

hemoglobin

suggest

as

extent

with greater
selectivity.
Except
during
active

tanding

maintain

empirical

orientation,

fractory

levels

to

treatment

poiesis

can

studies

that

aplastic-hypoplastic

sickle

by

so

accurately

precisely

hemolytic

been

retardation

so

more

mias-the

to inter-

it has

is

occur-

and

of various

been

eryth-

anemia

function

These

the

has

studies

undesirable

marrow
a similar

from

ditions

as in

be

pathogenesis

not

In

need

to the

anemia,

more

the

determine

children
periods

abnormality

pertinent

of occasionally
determine

to

enythnoblastosis

gested2#{176} that

need

chronic

a
limita-

changes

developmental

the

especially

cent.

these

the

and

normal

sions
result
in a potential

of

necessity

such

it may

fusion.

of

supply-

correcting

realizing

in infants
of the

ministrations

sickle

twelfth

function.

growth

pen

transfusions,

from

advisability
treatment

marrow

prematurity,

50

to 5 pen

the

is a re-

percentage
100

the
in

with

the

drawn

patients

emphasize
withholding

for

depression

the

detract

fetal

to

patients

from

circu-

and

multiple

day,

not

the

or

while

various

The
ized

left

in

hazards.

to

in

circulating

depends
understand-

reparation.

in-

observations

in

and

of whole

role

deficiency

state

and

at

which

1 patient

from

decreasing

anticipated

to appraise

resulted

amounted

maximum

twenty-fifth

specific

orders

transfusion

receiving

ropoiesis

The

in

these

a period

cells

cells
in

decrease

cent.

hemo-

component

after

In

pro-

endogenous

as donor

weeks

others

this

persisted

ing

ing

presence

hemoglobin

of

diminution

hemoglobin

the

levels

means.

of transfusion
its components
on a clean

A prerequisite

was

the

Transfusions

sharply

first

another

of fetal

of

of

tions

the

of transfusion
anemia

synthesis.

ing

a knowledge

tag

a depression
The

from

effectiveness

pathologic

blood

blood

by

amounts

creased

fol-

donor

eliminated

a biologic

lation.

week

until

effect

Mediterranean

globin

third

most

patient.

severe

vides

The

that
was

pretransfusion

further

of large

to

Not

603

blood
or any
of
in large
measure

hemo-

which

first

PEDIATRICS

SUMMARY

recipient
of the total

demonstrate

occurred

transfusion.

had

cell

to

OF

quantitative

and

circulating

possible

effect

lowing

permit

between
donor
by serial examinations

erythrocyte

globin

ACADEMY

blood

ne-

1. Schulman,
I., Smith,
C. H., and
Stern,
C. S. : Studies
on the anemia
of prematurity.
Am. J. Dis. Child.,
88:567,
1954.
2. Smith,
C. H., Schulman,
I., Ando,
R. E.,
and Stern,
(Cooleys)

C. : Studies
in Mediterranean
anemia.
1. Clinical
and hema-

Downloaded from by guest on October 23, 2016

SMITH

604

tologic
aspects
cia! reference
3.

thesis.
Pickles,

TRANSFUSIONS

IN

of splenectomy,
with
to fetal hemoglobin

Blood,
10:582,
M. M. : Haemolytic

1955.
Disease

Generalized

siderosis

and

with

pancreas

terranean)

in

anemia,

with

fibrosis

of

preservation

platelets;
factors

with
affecting

and

special

observations

survival

the clinical
effectiveness
platelets.
New
England
797,

rate

of

J.

14.

15.

of

to

the

16.

and

transfused
Med.,
248:

1953.

17.

Wiener,
A. S. : Prevention
of accidents
in
blood transfusions.
J.A.M.A.,
156:1301,
1954.
8. Mollison,
P. L. : Blood Transfusion
in Clinical Medicine.
Springfield,
Thomas,
1951.
9. Arthurton,
M., OBrien,
D., and Mann,
T.:
Haemoglobin
levels
in premature
infants. Arch. Dis. Childhood,
29:38,
1954.
10. Forum:
The
anemia
of prematurity:
Should
it be treated
by
transfusion?
Quart.
Rev. Pediat.,
8: 1, 1953.
11. Osgood,
E. E., Koler,
R. D., and Hughes,
M. E. : Differential
diagnosis
and treatment of hemorrhagic
diseases.
Arch. mt.
Med., 94:956,
1954.
12. Schulman,
Smith,
C. H., Erlandson,
M.,
7.

.,

and

Font,

E. : Vascular

hemophilia:

hemorrhagic

females

in

by

males

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TRANSFUSIONS IN PEDIATRIC PRACTICE: INDICATIONS AND


LIMITATIONS
Carl H. Smith
Pediatrics 1956;17;596
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright 1956 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.

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TRANSFUSIONS IN PEDIATRIC PRACTICE: INDICATIONS AND


LIMITATIONS
Carl H. Smith
Pediatrics 1956;17;596

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
/content/17/4/596

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright 1956 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.

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