Precautions to be taken while transfusing hemolytic child.

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Blood group typing:

i. Red cell typing of ABO & Rh-D (forward and reverse).

ii. Extended red cell antigen typing, at least C, c, E, e, and Kell, in order to provide phenotype matched blood where possible and to help identify and characterize antibodies in case of later development of allo-immunization.

iii. Periodically a Direct Coombs test (DCT) and antibody screening followed by compatibility testing

Those positive for antibodies should be given phenotype matched blood. Patients requiring antigen negative RBCs may be referred to a center where this is available.

Screening

 Regular screening for patients for hepatitis B, hepatitis C and HIV.

Vaccinations:

 Initiation of Hepatitis B vaccination for the patient and family members (if not vaccinated earlier).

 Routine vaccinations should continue as per the recommended schedule.

 In addition, all patients with thalassemia should receive hepatitis A, chickenpox and typhoid vaccinations.

Transfusions:

Normally , PRBC - 15ml/kg body weight, @ 5ml/kg/hr.

If in CCF or Hb <5g/dl,  5ml/kg or less of PRBC @ 2ml/kg per hour, with close monitoring.