Partial Volume Exchange Transfusion — Process for Calculation and Ordering — Clinical Pathway: ICU

Partial Volume Exchange Transfusion, Clinical Pathway, ICU

Process for Calculation and Ordering for Partial Volume Exchange Transfusion (PVET)

PVET for Anemia

  • Send Type and Screen and Blood Type Confirmation if not already sent
  • Call Blood Bank x42527 with the following information:
    • Birth hospital
    • Maternal blood type/antibodies
  • Previous patient transfusions prior to CHOP admission including fetal transfusions
  • Order PRBC STAT. Blood Bank will wash blood products.
Fluids used for exchange Calculate Exchange Volume Example
PRBC
  • Step 1
  • Calculate volume of PRBC needed for PVET based on patient’s weight in kg

  • (Desired HCT - Pt HCT) x wt x EBV
  • (PRBC HCT - Pt HCT)

  • Desired HCT = 35
  • PRBC HCT = 70, Hematocrit at CHOP assumed to be 70

  • Step 2
  • Order amount from Step 1 + additional
    50 mL PRBC used for priming blood warmer
  • Estimated blood volume (EBV) used in calculation below
    • Infants ≤ 1 month, use an EBV of 90 mL/kg
    • Infants ≥ 1 month, use an EBV of 70 mL/kg
  • PVET for anemia, use hematocrit of 70 for calculation
  • Patient weight = 2 kg, patient HCT = 15

  • ((35-15) x 2 kg x 90)
    (70-15)    		 = 65 mL PRBC

  • 65 mL + additional 50 mL = 115 mL PRBC

PVET for Polycythemia

Replacement solution to order NS as bolus in electronic health record

Fluids used for exchange Calculate Exchange Volume Example
NS
  • Step 1
  • Volume of blood to be removed based on patient’s weight in kg and estimated blood volume (EBV) to reach desired HCT of 55

  • (Patient HCT - desired HCT) x wt x EBV
  • Patient HCT

  • Desired HCT = 55

  • Step 2
  • Replace volume of blood removed with NS given via bolus
  • EBV used in calculation below
    • Infants ≤ 1 month, use an EBV of 90 mL/kg
    • Infants ≥ 1 month, use an EBV of 70 mL/kg
  • Patient weight = 3 kg, patient HCT = 76

  • ((76-55) x 3kg x 90mL/kg)
    76    		 = 75 mL of blood to remove from patient

  • Replace blood removed with 75 mL NS given via bolus