Children and young people (CYP) may need blood, platelet or white cell infusions due to the effects of chemotherapy or radiotherapy or as a consequence of the disease process itself.
Patients have their blood counts monitored regularly at their Primary Treatment Centre (PTC) or Paediatric Oncology Shared Care Unit (POSCU). They or their parent/guardian will be advised of their blood counts and encouraged to keep them in their shared care record. Families will know what symptoms to observe for and have been advised when to contact their centre or Clinical Nurse Specialist. Often CYP with cancer will tolerate relatively lower than normal range of blood counts than their healthy peers.
CYP may need to be transfused with the following products:
- Packed Red Blood Cells if symptomatic of anaemia; pallor, breathless, tiredness, tachycardia.
- Platelets to prevent or treat bleeding. Symptoms of thrombocytopenia (low platelet count) are excessive bruising, petechiae, bleeding gums, or epistaxis (Nose bleeds). Children and adolescents with leukaemia or solid tumours are allowed to reach quite a low threshold before platelets are given (to minimise blood product exposure), whereas children or adolescents with Brain Tumours are treated at a higher level due to the risks associated with bleeding in the brain (Estcourt et al., 2016a).
- Very rarely Granulocyte (white cell) transfusions are considered for severe life-threatening neutropenia which is not responding to antibiotics or antifungals. However, there is no strong evidence that it can improve infection outcomes (Estcourt et al., 2016b).
- Granulocyte transfusions are not the same as granulocyte colony-stimulating factor (GCSF) which is often used as a supportive measure during certain chemotherapy and transplant regimens. GCSF is not derived from blood.
All transfusions MUST be prescribed under the coordination of the PTC or POSCU where there will be a record of transfusion history. The following points need to be carefully considered:
- Special requirements such as irradiated or CMV negative products
- Children or adolescents may have developed antibodies due to previous transfusions
- Children or adolescents may have a history of reaction to certain blood products therefore requiring pre-medication and closer monitoring
- Staff are trained in blood transfusion competencies
Further reading
References
Estcourt, L.J., Stanworth, S.J., Dyer, C., et al. (2016a) ‘Guidelines for the use of platelet transfusions’, British Journal of Haematology, 176(3), pp. 365–394. doi:10.1111/bjh.14423.
Estcourt, L.J., Stanworth, S.J., Hopewell, S., Doree, C., Trivella, M. and Massey, E. (2016b) ‘Granulocyte transfusions for treating infections in people with neutropenia or neutrophil dysfunction’, Cochrane Database of Systematic Reviews, Issue 4, CD005339. doi:10.1002/14651858.CD005339.pub3.
Page last reviewed: January 2026