The Cribsiders S7 Ep151: Baby, Now We Got Good Blood! Pediatric Transfusion Medicine
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Sep 3, 2025 Dr. Rida Hasan, a pediatric hematologist and transfusion medicine expert from the University of Washington, shares her invaluable insights into the fascinating world of pediatric transfusions. She discusses why Type & Screen tests have a short expiration and unpacks the complexities of massive transfusion protocols in critical care. Rida also dives into the specifics of blood testing, the importance of donor demographics, and innovative practices that enhance patient safety. Join her as she navigates the challenges and joys of transfusion medicine!
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Plasma Dosing And Effect
- Plasma treats coagulopathy by replacing clotting factors and is dosed 10–15 mL/kg in pediatrics.
- Roughly 1 mL/kg of plasma raises coagulation factors by ~1%, so 10 mL/kg ≈10% factor increase.
INR Response To Plasma Is Nonlinear
- The INR-to-factor relationship is nonlinear; higher INRs gain more from plasma than near-normal INRs.
- Plasma offers limited benefit once INR is already near donor levels (~1.2–1.4), so transfusing to INR≈2 is often sufficient.
Four-Factor PCC Advantages
- Four-factor PCC contains factors II, VII, IX, and X and reverses warfarin rapidly with low volume.
- PCC is preferred over plasma for urgent warfarin reversal because it delivers concentrated factors without large fluid load.