Transfusion Volume 15 ml/kg vs 20 ml/kg

Andy (and others),
Are you aware of anywhere it is published regarding volume of blood for transfusions based on hemoglobin level? It is not in Standards of Care 2012.
I have heard others say that when hemoglobin is 8.8 or lower (or some say 8.2 or lower) the formula is 20 ml/kg  instead of the typical 15 ml/kg.
Our new daughter is supposively beta thal major (41/42 homozygote) but when 7 weeks between transfusions. (We are waiting on another gene test to see if there are any alpha or delta mutations along with the beta.) We should have transfused at week 6, but we were seeing if she'd go up (she did before, from 8.8 to 13!). So, on week 7, she had fallen from 8.5 to 7.8.   I was told the only formula they use is 15 ml/kg. We have never been below 8.8 with our son, so I have never encountered this before. The NP, nurses in the infusion bay, and MD were all adamant volume of blood is not more than 15 ml/kg and that I must be mistaken. I know from others who get transfusions in Atlanta, Oakland, and Boston, that if hem. is lower than 8.2 (or 8.8 in some cases) the volume formulat is 20 ml/kg. HOWEVER, I can't find that anywhere in writing.
Do you have any info?
I'd like something to print out and bring to our hematologist!
Thanks,
Nicole

The ideal transfusion volume is 14-15cc/kg.  Higher than this volume repeatedly may not be good for the heart because of the large volume of fluid that the heart must manage. 

The ideal transfusion volume is 14-15cc/kg.  Higher than this volume repeatedly may not be good for the heart because of the large volume of fluid that the heart must manage. 

Boston, Oakland, and Atlanta all use 20 ml/kg for children whose hemoglobin is less than 8.8 ....
15 ml/kg for patients between 8.8 and 10.5

I know it must be writing somewhere! I do have a photograph of a form used at the infusion bays at one of those hospitals during a transfusion, but when printed out it's not quite clear (but I could email the photo file to our doctor). I know it must be in writing somewhere, or in some studies...
Nicole

yes Nicole...My daughter got treated at Oakland and Boston and we have seen use 20 ml/kg for children whose hemoglobin is less than 8.8 and 15 ml/kg for patients between 8.8 and 10.5.

yes Nicole...My daughter got treated at Oakland and Boston and we have seen use 20 ml/kg for children whose hemoglobin is less than 8.8 and 15 ml/kg for patients between 8.8 and 10.5.

Thank you! We are going to Boston later this month for a consultation. Hoping the care plan they write up will specify the 20 ml/kg if less than 8.8 and that our local docs will follow that!
Nicole