Assessment of the prescription of red blood cell concentrates in the pediatric age group

Abstract

Objective: To verify the adequacy of red blood cell (RBC) prescription to pediatric patients in different sectors of a pediatric hospital. Method: A retrospective study was conducted including 837/990 RBC transfusion requisition forms for children and adolescents (0 to 13 years old) filed in between January 2007 and April 2015 by the pediatricians of the emergency room (ER), infirmary ward and intensive care unit (pICU). Transfusion requisition forms belonging to patients with chronic anemia or acute hemorrhage, as well as incompletes requisition forms, were excluded. Results: Trigger, prescribed volume and subtype of RBC concentrates were adequate in 532 (65.3%), 460 (58.8%) and 805 (96.2%) of the transfusions, respectively. When the clinical picture was considered, prescription adequacy was higher compared to the use of the hemoglobin level alone (70.9% vs. 41%). The pICU had the highest correct trigger percentage (343 [71.6%]; p<0.001) while the ER showed more often adequate prescribed volumes (119 [66.1%]; p=0.020). The most common inadequacy regarding volume was that of prescriptions above the recommendation > 15 mL/kg found in 309 cases (36.9%). Thirty-two (32) RBC subtypes were requested and none were consistent with current recommendations. Conclusion:The results obtained in our study showed that RBC transfusion occurred more appropriately when the clinical picture was taken into account at request. There was a tendency to prescribe higher volumes and RBC subtypes without the justification of current protocols. Hemotherapic teachings at undergraduate level and medical residency must be improved.

A Clinical Audit of blood component transfusion practices in Paediatric intensive care unit of a Tertiary Care Hospital, Rawalpindi

“…All components were transfused predominantly in children below one year in our study, similar results were seen in a study done about red cell concentrates transfusion in children (60.2%). 12 Present study also concluded that the most common blood group of recipients is O Positive and least being AB negative, reported similarly by Okoroiwu et al 13 in their study about blood component transfusions as 62% and zero respectively.…”

Incidentes transfusionais imediatos notificados em crianças e adolescentes

“…(7,20) Dados sobre a classificação das RT podem variar de estudo para estudo, fato que pode ser explicado devido às diferenças no relato da reação ou no registro dos sintomas pela equipe de enfermagem, uso de pré-medicação no paciente e até mesmo na aloimunização de pacientes politransfundidos. Os dados apresentados corroboram com a literatura nacional (5,7,15,19) e internacional (6,21) que reportam resultados semelhantes de maior frequência de RFNH e ALG. Contudo, quando analisamos as RT em crianças verifica-se que os dados apontam 77,2% e 69,8% para ALG e 14% e 27,2% para RFNH nos estudos de pacientes oncológicos (15) e pediátricos, (9) respectivamente.…”

“…(5) A transfusão de sangue é um fator de risco para mortalidade em crianças gravemente doentes, e podem causar reações imunológicas e não imunológicas mediatas. As RT em crianças podem ocorrer de 0,85% a 3,8% dos casos, (6) sendo as maiores de dois anos as mais vulneráveis. Entre 1.548 RT coletadas de um hospital universitário da cidade de São Paulo, observou-se que 12,4% ocorreram em crianças de zero a 17 anos de idade, (7) dados semelhantes aos relatados em um hospital de ensino da Índia, onde os autores referem 11,6% de RT em crianças.…”

Red blood cell prescription and recognition of transfusion reactions by pediatricians

“…(1) Sepsis is the major cause of transfusion in symptomatic children in our region and the trigger is 10.0g/dL. (7) The volume of RBC prescribed should be between 10 and 15mL/kg. (1) The main indications for specific RBC subtypes are filtered (immunosuppressed and polytransfused children), irradiated (immunosuppressed and related donors), washed (previous transfusion-related anaphylaxis), and phenotyped (polytransfused patients).…”

“…( 1 ) A sepse é a maior causa de transfusão em crianças sintomáticas em nossa região e possui gatilho de 10,0g/dL. ( 7 ) O volume prescrito de CH deve estar entre 10 e 15mL/kg. ( 1 ) As principais indicações de subtipos específicos de CH são filtrados (imunodeprimidos e politransfundidos), irradiados (imunodeprimidos e doação aparentada), lavados (anafilaxia prévia relacionada à transfusão) e fenotipados (politransfundidos).…”