Paediatric Major Haemorrhage Flowchart

Paediatric Major Haemorrhage Management - RHC SITE ONLY

 To activate: Call: 2222 

State: ‘Major Haemorrhage, Children’s Hospital’ or ‘CODE RED, Children’s Hospital’ ahead of arrival for pre-alerted patients. Give the location of the patient and most suitable extension number to use. 

This will alert: Haematologist, Resus Team, Blood Bank, Haematology, Blood Delivery Team, Hospital Porter,  Hospital Co-ordinator & Theatre. 

Nominate: Communication Lead – handle all calls including Blood Bank on a dedicated extension
Haemorrhage Monitor –keep track of components requested, given and estimated losses.

*If porters do not arrive, a runner should be allocated to take blood samples and request forms /
collection cards to the laboratory. There is a buzzer to alert laboratory staff out with office hours.

Blood Bank will phone the number supplied to switchboard in response to the 2222 call

When Blood Bank call they want to know:
•Patient name (if known)
•Unique Identifier i.e. CHI or TJ (if known)
•What blood/products are required and whether cross match samples have been sent
•Blood Bank have a Major Haemorrhage direct line number 82277 for ongoing communication.
(only to be used in a Major Haemorrhage)
Initial products available for Immediate Use

It is important to send 2 cross match samples if possible before transfusion of emergency Group O
RhD Negative blood.

4 units of Group O RhD Negative are available in the Paediatric Theatre Fridge
4 units of Pre thawed FFP and 1 unit of platelets are available from the lab

Blood bank must be informed when emergency O RhD Negative is removed from the theatre fridge.

Subsequent products (Red cells, FFP, Platelets etc.)

Further Emergency Group O RhD Negative red cells, FFP, Cryo and platelets can be issued on request
without a form until the patients blood group is confirmed by 2 samples after which a fully completed
request form & collection card are required. Use Trakcare to order products. If this is not possible or
patient is unknown, hand write paper downtime forms which are available in the resuscitation trolley in
the ‘Major Haemorrhage’ folder, or from Staffnet by typing ‘downtime form’ into the search box.

•Platelets supplies are limited so these may be delayed

•Cryoprecipitate and FFP need to be thawed before leaving blood bank (approx. 30 mins)

•Take blood for:
2 x Crossmatch –pink bottle (following the GGC 2nd sample rule)
Clotting –blue bottle
FBC –pink/purple bottle
U&Es –green bottle

Remember to handwrite the crossmatch sample correctly; forename, surname, DoB & Unique
Identifier and sign the form and sample. The sample will be rejected if not labelled fully and
accurately.

Remember to also send (or order on TrakCare) a collection card at the same time

Inform Blood Bank if the patients clinical situation can wait for fully crossmatched products or
if you need to continue with emergency products.

Notes:

•Assess weight of patient
•Platelet availability: a limited stock of platelets are held on-site
•Always remember ‘thaw time’ for Cryo and additional FFP can be up to 20mins
•The EZIO drill is a specifically designed intraosseus drill for fluid and blood administration, with sizes appropriate for all ages. It is available in ED and Theatre 6 (ext 84358)
•The laboratory cannot process a marrow sample
•Blood warmer can be obtained from Theatre (ext 84358)
•Blood Bank Major Haemorrhage (ext 82277)
•MLA Blood Delivery Team page 17262
•REMEMBER COMMUNICATION LEAD MUST NOTIFY BLOOD BANK TO ‘STAND DOWN’ WHEN APPROPRIATE

Calculate additional requirements by patient weight

Packed cells     20mls/kg 
Cryo                   5mls/kg             
FFP                   20mls/kg           
Platelets           10mls/kg


Note: Blood Bank will not supply blood/products in mls they will supply units.