Paediatric major haemorrhage protocol (children under 50kg)

1. Call 2222 state "Paediatric massive haemorrhage ward X":
   • Switchboard will voice page duty bleep holder, transfusion lab BMS, duty porter, transfusion practitioner, haematology registrar.
   • Out of hours: also page operational coordinator and hospital at night coordinator.
2. Call blood bank ext 33394 state "paediatric massive haemorrhage": give patient name, CHI, location, your name and contact details.
3. Call for additional support and nominate: team lead and communication lead to hand all calls.
4. Send urgent blood samples: 
   • FBC
   • Coagulation screen
   • Fibrinogen
   • Cross match
   • U & E
   • Calcium
5. Request blood components:
   • red cells
   • FFP
   • platelets
   • note: all paedipacks contain SAG-M
6. Resuscitate patient "ABCDE" approach:
   • Use emergency O RhD negative blood if required immediately
   • Red cell transfusion 5ml/kg alternating with FFP 5ml/kg
   • Trauma less than 3 hours - consider tranexamic acid 15mg/kg IV
   • Aim to control haemorrhage
   • Use blood warmer
7. Ongoing bleeding while awaiting blood results:
   
   • Transfuse further RBC in 5ml/kg aliquots
   • FFP in 5ml/kg aliquots
8. When blood results available maintain:
   • Hb over 80g/L
   • APTT and PT ration under 1.5
   • Platelets over 75 x 10⁹/L
   • Fibrinogen over 1.5g/L 
9. Bleeding controlled:
   • Communication lead to notify blood bank to "stand down"
   • Complete massive haemorrhage activation record proforma

Contact numbers:

• Ninewells Transfusion lab 32953
• PRI transfusion lab 13338 (bleep 5122 out of hours)