The child or young person will have their blood counts monitored regularly at their Principal Treatment Centre or shared care centre and will be advised of these and encouraged to keep them in their shared care record. They will know what symptoms to observe for and have been advised when to contact their centre or Paediatric Oncology Outreach Nurse Specialist (POONS). Often the child or adolescent will tolerate relatively lower than normal range of blood counts.
Children or adolescents may need to be transfused with the following products:
- Packed red cells if symptomatic of anaemia; pallor, breathless tiredness, tachycardia
- Platelets to prevent or treat bleeding. Signs to look out for at home are excessive bruising, petechiae, bleeding gums. Children and adolescents with leukaemia or solid tumours are allowed to reach quite a low threshold before platelets are given (to minimise blood product exposure), whereas children or adolescents with brain tumours are treated at a higher level due to the risks associated with bleeding in the brain.
- Very rarely granulocyte transfusions are considered for severe life threatening neutropenia which is not responding to antibiotics or antifungals. This is not the same as granulocyte colony-stimulating factor (GCSF) which is often used as a supportive measure during certain chemotherapy and transplant regimens. GCSF is not derived from blood.
All transfusions MUST be prescribed under the coordination of the Principal Treatment Centre where there will be a record of transfusion history. The following points need to be carefully considered:
- Special requirements such as Irradiated, CMV negative products
- Children or adolescents may have developed antibodies due to previous transfusions
- Children or adolescents may have a history of reaction to certain blood products therefore requiring premedication and closer monitoring
- Staff are trained in Safe Transfusion Competencies Right Patient Right Blood (RPRB).
Further reading:
British Committee for Standards in Haematology (BCSH) http://www.bcshguidelines.com/
National Patient Safety Alert http://www.nrls.npsa.nhs.uk/resources/collections/right-patient-right-blood/
Granulocyte transfusion http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/granulocyte-transfusions-directed-donation-and-buffy-coats