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PEDIATRIC
PRACTICE:
AND LIMITATIONS
By
Department
HE
sharp
fusions
of
rise
have
data
tions
and
risks
of this
such
been
greatly
tion
has
been
and
treatment,
plications
while
An
has
relating
with
to
of
Except
be
selectivity
either
its
components
Although
been
the
the
for
pediatric
had
a special
be cited
supportive
Clinic
of
New
York
dren
receive
flic
data
Arthritis
based
on study
the
the
Pediatric
Hospital.
a total
included
and
in
in
Division
this
of
approximately
this paper
Metabolic
Diseases,
Inc.,
part
and
before
525 East
the
clinic
are
Street,
scrutinize
of
The
niicaiities
50
chil-
tory
based
period,
blood
certain
the
is to
dechroni-
to
the
possibility
hematopoiesis
by
other
of
trans-
of
on
studies
Public
to
transfusion
certain
its
Health
(RG
3,
York
Nv
21,
1955.
York.
596
from
A-227
pedi-
to the
risks,
and
techThe
prepara-
summarized
a basis
by grants
Service
the
in relation
potential
Company.
October
need
in
preliminaries
administration.
provide
supported
FACTORS
IN
THERAPY
entails
considerations,
I, itlS()
States
New
approach
growth
500
United
difficulto choice
in
and
treatment,
patient
which
from
Mead Johnson
and
Annual
Meeting,
Sixty-eighth
The
atnic
Transfusion
In
major
refractory
SIGNIFICANT
TRANSFUSION
to
of patients
Out-Patient
patient
sensitifactors,
fusion.
I have
observations
The
hemosiderosis
intrinsic
selected
and
The
of
depressing
ages,
have
and
at which
almost
of
such
group
of levels
of hemoglobin
be
administered,
the
anemic
of
plasma,
primarily
cally
trans-
jaundice
frequently.
velopment
find
of
blood
clinic
the
transfusions
serum
this
of
safeguards,
lessen
less
clinic
in large
services
multiple
commonly
the
this
inpatient
relate
in
from
are
associates
and
Foundation,
Presented
ADDRESS:
These
my
interest.
are
wards
11100(1
state.
some
of
consideration
standpoint.
in
of
ties
to
less
and
manifold
in
of available
from
to
forms
special
which
topics
the
occur
a de-
relating
use
and
zation
The
parallel
of the
as homologous
blood
eventually
problems
accumulate
and
leukemia
to transfusions
those
blood
whole
and
may
that
hospital.
With
the
supply
red-cell
anemia,
of enyth-
disorders
diseases.
regard
severe
num-
pure
with
systemic
complications
and
are common
to patients
of all
phases
of recent
developments
chosen
any
on
prescribe
pathologic
even
tonic
effects
of a transfusion
a scientific
basis.
associated
anemias
measure
ad-
emergency,
from
the
to
to
correct
a
knowledge
presumptive
these
examination
tests
ficiency
on to
With
expanding
fusions
certain
in an
possible
laboratory
greater
one
hemorrhagic
the
a predetermined
physical
appropriate
the
of
with
in smaller
anemia,
roblastosis,
with
emphasis
growing
cell
ambulatory
those
and,
lat-
in the
an
largely
anemia
problems
corn-
the
need.
ultimately
history,
untoward
include
various
scrutiny.
a transfusion
clinical
their
consequence
been
physiologic
it should
prevention
under
important
vances
to
patients
on
congenital
aregenerative)
in the convalescent
phase
infants
atten-
The
treated
sickle
(chronic
reacand
are
and
bers,
Center
yearly.
group
Mediterranean
serum
clarified
other
still
ten
have
been
The
pathoas
Medical
transfusions
basis
transfusion
directed
are
and
limita-
complications
hemolytic
M.D.
Hospital-Cornell
accumulation
procedure
and
Smith,
York
of trans-
indications,
delineated.
of
hepatitis
tions
has
the
the
precisely
genesis
number
in
which
H.
New
of blood
in the
resulted
by
more
or
availability
J.NGREASED
the
Carl
of Pediatrics,
INDICATIONS
for
the
(C5)),
in
the
Table
indications
National
The
Institute
Childrens
AMERICAN
BACKGROUND
TABLE
FOR
TRANSFUSION
DATA
ACADEMY
OF
PEDIATRICS
globin
and
fore,
THERAPY
enythrocyte
come
iITltO
quently
Blood volume-80
Plasma
volume-45
mI/kg.
Erythrocyte
volume-35
Hemoglobin
concentration-12-13
gin./100
ml.
Hematocrit-36%
1.0
gm.
100 ml.
500
Hemoglohin=3.4
ng.
whole
Transfused
nsl.
Transfused
whole
mg.
and
pressed
as
115g.
being
hlood-20
nil/kg.
when
body
wt.
less
than
25 kg.
-units
of
500
than
Packed
erythroevtes-15
nsi./kg.
-units
iiire
wt.
less
80 nil.
of
when
body
wt.
20 kg.
than
certain
of the
limitations
therapy.
Blood
Volume:
Plasma,
Hemoglobin
and
A knowledge
almost
of
need
for
recognizing
volume,
and
plasma
was
shock
restitution
rhage
so
that
could
be
associated
accompanying
lesions,
when
calculated
exchange
volume
of
of
at
least
represents
ation
of
for such
fluence
determination
and
therapeutic
terms
of variations
of
by
transfusions
ml.
in the
when
in
the
Blood
into the
an
more
estimated
as
counted
for
evalu-
these
globmn
patients
values
the
need
in-
in plasma
volume.
The
total
circulating
hemo-
transfusion
In
our
a sharp
who
were
in
for
of
such
at levels
not
as
104
with
in
values
from
crisis.
volume
and,
crisis
decrease
in plasma
on
ac-
disability
ml.
is associated
volume
of
hemowithout
6 to 7 gm./100
experience
high
peripheral
maintained
of
exceed
probably
freedom
whose
were
to
plasma
hemodilution,
the
the
of patients
increase
responsible
of
experience
values
henio-
the
the
administration
number
basis
life.
has
with
was
volume
in calculating
in a small
the
cmsta-
of 85 ml./kg.
In our
anemia
total
either
blood
found
total
or
to
has
permit
eliminating
the
been
cell
week
anemic
throughout
value
transfusion.
inordinate
in
of
sixth
had
applies
prior
normal,
sickle
to
that
accurate
volume
to
as Mediterfor in-
convalescent
the
volume
ml./kg.
An
fourth
mass
I,
prior
refractory
postponed
begun
to rise.
exceptions
the
Table
found
the
blood,
the
it is found
newborn
blood
be
in
concentrations
so-called
or had
certain
reand
level
with
can
at
contakes
hemoglobin
anemia
such
erythroblastosis,
In
hemoglobin
cited
the early
determi-
infant1
hemoglobin
of life
blood
which
the
of
mass
stance,
with
of
patient
exchange
practice.
procedures
procedures
or
organic
whole
twice
erythrocyte
hemolytic
bilized
With
of
frequently
of growth
and
helpful
in recog-
hemoglobin
the
chronic
nanean
been
hemor-
transfusion
in
current
in
on
for
or plasma.
now extend
erythnoblastosis
the
In
disorders
burns,
of
Comparisons
globin
Acute
feasible
amounts
in
physiologic
blood
erythrocyte
suspensions
volume
measurements
treatment
erythrocyte
recognized
planned.
shock,
call
evaluating
phases
adequate
with
states
premature
culating
early
the
factors
proved
in the
and
of
the
has
initial
The
blood
are
estimations
mass
generation
treatment.
and
periodic
into
account
hemodilution,
syndromes
their
fluctuations
the
compartments,
surgical
for
inter-
deter-
the peripheral
hemoglobin
This
calculation,
which
8 gm./100
volume
in the
clinical
clues
of
centration.
patients
in blood
mandatory
many
in providing
Circulating
Mass
of the shifts
become
pretation
Total
Erythrocyte
readily
valuable
in detecting
of hemoglobin
than
transfusing
of transfusion
(excirculat-
transfusions
hemoglobin
prove
more
regeneration
nizing
mi/kg.
be
can
which
in
sample.
of body
measurements
the total
ml.),
mass
absolute
nation
20 kg.
more
and
body
wheti
than
Plasira-10-15
I)1)dV wt.
when
iii!.
25 kg.
blood
(80 ml./kg.
hemoglobin
cases
it fre-
conclusions
peripheral
volume
considered,
the
Whole
there-
because
use
gm./100
In
has,
erroneous
hemoglobin
mined.
1)lood-average-250
greater
blood
weight)
iron
Dosage:
of
the
ing
iron
blood-average-SO
iron
has
from
From
mI/kg.
content
obviates
drawn
mi/kg.
597
with
but
the
598
SMITH
amount
no
of
hemoglobin
change.
In
precnitical
plasma
with
attempt
to
dextran
on
restore
the
concentration,
and
moderate
IN
little
undergoes
an
plasma
blood,
TRANSFUSIONS
have
been
PEDIATRIC
with
the
the
PRACTICE
associated
individual
whole
agement
we
given
ceptions,
patients
gory
success.
of
have
Acute
and
and
Chronic
In the
in
level
of
blood
loss
patient
the
who
of severe
the
in
with
a sufficient
the
in
acute
In
severe
iron
the
effects
cent.
With
anemia
or
the
need
deficiency
less
urgent
of specific
ally stabilize
gm./100
ml.
blood
be
erythnocytes,
may
severe
anemia,
may
be advisable
digitalization
of elevated
venous
of congestive
to prevent
Similarly,
verely
anemic
in
of
venous
pressure
of
with
with
packed
blood
need
in the
anemia
is
transfusion
patient
the
Provided
quate
completely
globin
need
if
transfusion
required
functioning
bone
raise blood
levels
The hemoglobin
of the
chronic
is indicated
mia,
marrow
in patients
cannot
aneniia
be
arbitrarily
and
sickle
fixed
into
of
transfusions
for
each
re-
patient.
overload
or
gm.
of
15
storage
10.5
quate
the
by
parent
that
deposits
in normal
or
with
severe
greatly
and,
in
the
function
cell
ane-
creased
of
absorption
to madegrowth,
may
be
of iron
iron
storage
in
from
availmulti-
500
increase
accessory
of
iron
stems
iron
ml.
hemosiderin
depots
addition,
of
body
I it is ap-
become
receiving
gm.
iron
the
Table
conditions
deand,
of approxi-
amounts
such
8.5
states
due
leave
From
(.25
Under
the
chil-
rapid
excretion
erythrocytes
in patients
transfusions
in
In
In
and
cannot
excessive
anemias
varies
represents
accumulates
normal
bleeding.
source
of
taxed
daily,
blood).
other
cent
weight.
periods
broken
down
able for storage
assume
from
amount
of
4 to 5
represents
body
otherwise
1 mg.
except
pen
normally
are
iron
resulting
in infancy,
and
for
have
of
The total
approximates
20
of
deficiency
except
mately
to
iron
diet
metabolism
stored
principally
and hemosidenin.
mg./kg.
dis-
ple
as
iron
investigation
hemosiderosis
reserve
fennitin
Iron
are
in
an
which
pleted.
each
Hemosiderosis
a trans-
but
usu-
6 and 7
or inter-
regardless
between
repeated
transfusions.
iron in a normal
adult
sub-
eventually
with
group
such
levels
and
study
studies
extended
depots
blood
will
latter
is much
these
criteria
find genamounts
of blood
given
and
storage
A normally
to desired
values.
value
at which
intervals
ade-
of hemo-
of
this end.
aplastic-hypoplastic
hemolytic
anemias
Mediterranean
be
with
amounts
to accomplish
the
of iron
is
levels
attained
and
to
hemorrhage.
hemorrhage
levels
eral
dren
hemorrhagic
be
large
patient
contrasted
blood
normal
not
the
will
activities
specialized
sickle
the
hemoglobin
Although
application,
the
the iron
liven as
of whole
marrow
chronic
to perif the
transfu-
be
acute
normal
In
orders,
to
of acute
bone
to maintain
sequently.
fusion
with
cause
the
corrected,
to
for
rapid
seand
The
with
In
in a range
between
without
discomfort
with
point
While
group
of
unless
transfusions
treatment.
Recent
the
elevated.
patient
repeated
de-
at which
differently.
because
ference
quine
sys-
digitalized,
enythnocytes
chronic
the
2 portions
blood
withdrawn
prior
of exchange
transfusion
is
for
ex-
levels
ml.,
the
given,
reacts
Transfusions
into
circulatory
is often
few
in this catenot
require
signs
calculated
erythroblastosis
infant
50 ml.
fonmance
sion
the
other
The
is divided
overloading
tem.
and
failure.
of blood
amount
of 12
of 36
preliminary
in the event
pressure
heart
is
cell
given
to achieve
hemoglobin
levels
to 13 gm./100
ml. and an hematocnit
per
treatment
the
of whole
amount
packed
with
hemoglobin
to 7 to 7.5 gm./100
of
to man-
clinical
symptoms
usually
appear.
blood
levels
in children
with
this
diseases
tend to decline
progressively
normal
anemia.
symptoms
a guide
that
found
until
crease
hemorrhage,
ill to await
or, preferably,
different
chronic
nonrecurring
infant
therapy,
of
is
than
is too
in
anemia,
restoration
hemoglobin
with
Levels
Anemias
management
objective
in
Hematocrit
and
As
with
illness
anemias
do
chronic
transfusions
Hemoglobin
signs
patient.
sites
storage.
from
from
Anthe
tile
in-
diet
ANIERICAN
manifested
tony
in patients
anemia.
ingly
demonstrated
with
severe
liver
at necropsy
after
receiving
in
iron
controversial
iron
be
Ourstudies
anemia5
siderosis
have
and
that
was
that
no
unequivocal
pancreas
about
the
vention
of
accessory
hypoxia
deposits.
From
seem
the
compatible
moderate
with
single
transfusion,
ment
in
and
and
While
the
blood,
packed
frequently
the
levels
and
erythrocytes
and
an
rhage
a
clear-cut,
appraisal
of
they
other
of hemoglobin
and
blood
simultaneous
whole
blood
clotting
appropriate
cytes
plasma,
is of value
mechanism
by
plasma
lost
by
factors
or a combination
to
days
the
Packed
are
on
than
the
erythrocyte
count.
anemia
Fresh
in disorders
of the
both
the
Whole
a pant
the
erythro-
states
tomy,
and
Plasma
when
transfusions
protein
in
of
In
plasma
regulating
a hematocnit
blood,
pared
with
in the
blood
and
the
dosage
that
and
60
to
50
70
to pooled
risk
of hepatitis.7
should
blood
per
pen
of frozen
superior
it
citrated
to
con-
supply
In
units
of 32 to 36 per
40
volume
and
hypoproteinemia.
are
in diminishing
membered
blood
available
individual
group-specific
plasma
restore
cases
the
splenec-
hemorrhage
deficiencies
hemophilia,
in
for
states.
is not
clotting
in idio-
punpuna
controlling
blood
This
useful
thrombopenic
whole
some
true
in
horbe
cumbersome
in preparation
also
in secondary
can
platelets.
is especially
and
the
silicone-
emergency,
agents
and
more
thrombocytopenic
active
rect
with
viable
providing
of therapy
pathic
whole
transfused
with
when
supplanted
of
from
platelets
have
depend
play
blood
provides
4
easily
hemon-
in
the
hemostatic
often
and
is more
Platelet-rich
of
sus-
controls
intravenously
as effective
factors
hemorrhage.
blood
donors
as
platelet
given
serve
plasma
supplying
as effective
is to neto the
volume
and
correction.
when
require
be
presumably
the trans-
syringes.6
Adnenocorticotropic
(ACTH)
and cortisone,
which
A lange
body
of experience
has
demonstrated
the superiority
of whole
blood,
especially
not
frequently
span
in
second-
coated
mone
and
cardiac
with
concentrated
satisfactorily.
survival
due
to the
bone
of aplastic
anemia
and
during
chemotherapy,
whole
polycythemic
in
treat-
with
is directly
of
or
enythro-
an ideal
patients
may
of
fresh
the
gam-
dose
blood
Blood,
dosage
packed
larger
associated
of platelets
attainable
Plasma
choice
in
use
the
chonic
anemias
refractory
of therapy.
However,
episodes
the
by
by
in the
over
the risk
comfort
of Whole
of
a
infancy,
methods
Dosage
replaced
needed,
directly.
any
thrombocytopenia
marrow
depression
leukemia,
especially
form
Erythrocytes
circulating
in combat-
represents
failure,
and
in
to other
forms
pensions,
activity.
Choice
of
been
pro-
support
globulin
permitting
iron
A con-
prudent
course
of transfusions
by
with
it
however,
transfusions
view
of
transfer
fraction
con-
from
is harmless.
the most
number
minimum
as
the
gamma
administration
cytes,
fen
large
derived
globulin
and
immunologic
fresh
whole
blood
is preferable
for its platelet
content.
While
inter-
considerations
trary
situation
may prevail,
patient
receiving
multiple
long
periods
of time.
In
the
to
iron
transfusion
involved,
such
addition
these
that
occasional
on the
factors
in
the
and
characterizes
depend
by
bleeding
that
hemocoexist
al-
which
may
exis
Mediterranean
uniformity
diarrhea
The
and
The
injurious.4
however,
frequently
no
ma
ex-
made
as to the
tissue
sidenosis
of dehydration,
ting infection
has now
antibiotics
and, when
still
It has been
suggested
that
of true
hepatic
cirrhosis
of the
strict
of iron
599
deficiency.
antibodies
transfusion.
blood
may
is
of severe
hemochromatosis
would
14 gm.
is potentially
shown,
fibrosis
there
tinued
whose
by
PEDIATRICS
represented
patients
is evidence
as yet be
in which
harmful.
fibrosis
there
understood
progression.
development
our
tein
anemia
transfused
storage
statement
can
tent
on manner
though
of
OF
treatment
strik-
hemochromatosis
but
It must
one
6.5 gm.
from
refracwas
contained
only
produce
cessive
chronic
phenomenon
Mediterranean
Whether
actually
with
This
ACADEMY
be
usually
cent8
cent
cent
rehas
as cornfor
for
whole
packed
600
SMITH
enythnocytes,
TRANSFUSIONS
depending
supernatant
plasma
In erythroblastosis,
of hematocnit
the effects
on
of recipient
of swelling
solution
justed
by
itial
Mollison8
replacement
transfusion.
atocnit
of
5 per
tocnit
with
negative
guides
for
the
to be
given
In
case
of
erythrocytes
on the
ing
safe
limits
ing
weight
and
figures
other
criteria
the
and
of
clinical
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
is brought
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
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
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
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,
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of prematurity.
Am. J. Dis. Child.,
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C. H., Schulman,
I., Ando,
R. E.,
and Stern,
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C. : Studies
in Mediterranean
anemia.
1. Clinical
and hema-
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
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with
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of
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platelets;
factors
with
affecting
and
special
observations
survival
the clinical
effectiveness
platelets.
New
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rate
of
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14.
15.
of
to
the
16.
and
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Med.,
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17.
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1951.
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Haemoglobin
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E. E., Koler,
R. D., and Hughes,
M. E. : Differential
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Arch. mt.
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C. H., Erlandson,
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.,
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Reprints
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.
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.