Paediatric Blood Transfusion — FRCA Final MCQ

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ModeratePaediatric AnaesthesiaPaediatric Blood TransfusionFRCA Final

Following control of surgical bleeding and restoration of circulating volume, a 3-year-old child weighing 14 kg has a haemoglobin concentration of 70 g/L. A top-up red-cell transfusion is prescribed to increase the haemoglobin to 80 g/L. What volume of red-cell concentrate should be prescribed?

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Correct answer: C — 56 mL

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · E = shown as D · B = shown as E

The correct answer is A, 56 mL. For a paediatric top-up transfusion, the red-cell volume is calculated as: desired haemoglobin increment (g/L) × weight (kg) × 0.4. The required increment is 80 − 70 = 10 g/L; therefore, 10 × 14 × 0.4 = 56 mL, equivalent to 4 mL/kg. Option B represents 5 mL/kg, an imprecise rule of thumb rather than the specified UK calculation. Options C, D and E correspond to 10, 15 and 20 mL/kg respectively and would be expected to produce a substantially greater haemoglobin increment. This top-up calculation assumes haemostasis and stable circulating volume; it is not an appropriate standalone method during ongoing major haemorrhage.

Reference: Norfolk and Norwich University Hospitals NHS Foundation Trust. Trust Guideline for the Transfusion of Blood and Blood Components in Adults and Children, section 3.9.2, 2023. https://www.nnuh.nhs.uk/publication/download/transfusion-of-blood-and-blood-components-v8-2/