TRANSFUSIONS IN PEDIATRIC PRACTICE: INDICATIONS AND LIMITATIONS

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Abstract
The effectiveness of transfusion of whole blood or any of its components depends in large measure on a clear understanding of the anticipated role in supplying a specific deficiency or correcting a pathologic state while realizing the limitations and hazards. A prerequisite in infants and children is a knowledge of the normal changes occuring at various developmental periods so as to appraise the abnormality more accurately and to determine the need and extent of reparation. The pathogenesis of various bleeding disorders has been more precisely characterized so that treatment can be prescribed with greater selectivity. Except during active hemorrhage, holding blood requirements to a minimum frequently serves the patient to greater advantage than maintaining normal hemoglobin levels by frequent and maximal administrations of blood. This restriction is especially pertinent in the refractory anemias—the aplastic-hypoplastic and chronic hemolytic groups. Here multiple transfusions result not alone in hemosiderosis but in a potential suppressive effect on erythropoiesis and hemoglobin synthesis. The retarding effect of transfusion must also be considered in the management of the convalescent anemic phase of erythroblastosis and in the anemia of prematurity. It should be emphasized that the hemoglobin concentration at which transfusion is indicated for patients who require single on multiple administrations of blood cannot be arbitrarily fixed but varies with the attendant clinical signs and symptoms and the promise of relief by this form of treatment.

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