Children are not little adults: blood transfusion in children with burn injury

Palmieri, Tina L

doi:10.1186/s41038-017-0090-z

Cited by 20 publications

(14 citation statements)

References 38 publications

(33 reference statements)

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“…Blood transfusion in injured patients has previously been demonstrated to exacerbate hypocalcaemia [11,27] due to citrate-induced calcium chelation [28]. Additionally, current massive transfusion protocols dictate transfusion of high ratios of FFP [29] which has also been independently associated with hypocalcaemia [10, 30,31]. We therefore hypothesize that patients with admission ionized hypocalcaemia as observed in this study are likely to become more severely hypocalcaemic during haemostatic resuscitation [25,26].…”

Section: Discussionmentioning

confidence: 74%

Hypocalcaemia and traumatic coagulopathy: an observational analysis

et al. 2019

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Background and Objectives Haemorrhage‐associated calcium loss may lead to disruption of platelet function, intrinsic and extrinsic pathway‐mediated haemostasis and cardiac contractility. Among shocked major trauma patients, we aimed to investigate the association between admission hypocalcaemia and adverse outcomes. Materials and Methods Data were extracted from the Alfred Trauma Registry and the Alfred Applications and Knowledge Management Department for all adult major trauma patients presenting directly from the scene with a shock index ≥1 from 1 July 2014 to 30 June 2018. Patients with pre‐hospital blood transfusion were excluded. Ionized hypocalcaemia was defined as <1·11 mmol/l, and acute traumatic coagulopathy was defined as initial INR >1·5. Multivariable logistic regression analysis was used to assess the association between admission hypocalcaemia and acute traumatic coagulopathy that was adjusted for Injury Severity Score, initial GCS, bicarbonate and lactate. Results There were 226 patients included in final analysis with 113 (50%) patients recording ionized hypocalcaemia on presentation prior to any blood product transfusion. Ionized hypocalcaemia was associated with coagulopathy in patients with shock index ≥1 (adjusted OR 2·9; 95% CI: 1·01–8·3, P = 0·048). Admission ionized hypocalcaemia was also associated with blood transfusion requirement in the first 24 h post‐admission in 62·5% of hypocalcaemic patients as compared to 37·5% of normocalcaemic patients (P < 0·001). Admission ionized hypocalcaemia was associated with death at hospital discharge (25·6% among hypocalcaemic patients compared to 15·0% of normocalcaemic patients (P = 0·047)). Conclusion Hypocalcaemia was a common finding in shocked trauma patients and was independently associated with acute traumatic coagulopathy. The early, protocolized administration of calcium to trauma patients in haemorrhagic shock warrants further assessment in randomized controlled trials.

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Section: Discussionmentioning

confidence: 74%

Hypocalcaemia and traumatic coagulopathy: an observational analysis

et al. 2019

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“…The German guidelines for blood transfusion recommend a threshold of 6 to 7 g/dL (hemodynamically stable) and 10 g/dL (hemodynamically unstable) for children older than 4 months with active bleeding [ 16 ]. These guidelines do not specifically address children with burn injury, thus special Hb thresholds for this collective are not available in a guideline because available prospective randomized data of critically ill children without acute blood loss cannot be fully be applied to pediatric patients with burn injury [ 26 ] International guidelines propose lower guidelines for children with bleeding, but they do not specify Hb thresholds for unstable children because of insufficient data [ 13 , 14 ]. 74% of the children were transfused too liberally.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, children with burn injury could benefit from a restrictive transfusion practice in particular. Apart from that restrictive transfusion practice minimizes other adverse effect of transfusion in children like hyperkalemia [ 26 ], TACO, febrile hemolytic transfusion reactions and incorrect blood component use [ 11 , 12 ]. Indeed, prospective studies in burned children examining the effects and safety of restrictive versus liberal regimen are lacking.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative transfusion practice in burned children in a university hospital over four years: a retrospective analysis

et al. 2021

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Background Patient blood management programs should be applied to the pediatric population, but little is known about the current transfusion practice of pediatric burn injury patients. This retrospective study was performed to evaluate the practice of red blood cell (RBC) transfusion in children with burn injury, their predictive factors, and adherence to the German transfusion guideline. Methods We reviewed the RBC transfusion practice of all children younger than 8 years with burn injury who were operated during a four-year period in a German university medical center. We analyzed the data associated with transfusion and guideline conformity of transfusion triggers for RBCs from the beginning to the end of hospital stay using logistic regression. Results During the four-year period, 138 children (median age 21 months, minimum-maximum 9–101 months) with burn injury needed surgery, 31 children were transfused with RBCs. During their hospital stay, the median hemoglobin concentrations (Hb) of transfused and non-transfused children were 8 g/dL (6.3–11.3 g/dL) and 10.7 (7–13.8 g/dL), respectively. Total body surface area burned (TBSA) (OR = 1.17 per % TBSA, 95% CI = [1.05; 1.30], p = 0.0056), length of surgery (OR = 1.016 per minute, 95% CI = [1.003; 1.028], p = 0.0150), and Hb (OR = 0.48 per 1 g/dl in Hb, 95% CI = [0.24; 0.95], p = 0.0343) were associated with transfusion while other factors (age, gender, ASA, and catecholamines) did not show notable association. Length of stay was mainly influenced by TSBA (+ 1.38 days per %, p < 0.0001), age (+ 0.21 days per month, p = 0.0206), and administering of catecholamines (+ 14.3 days, p = 0.0118), but not by RBC transfusion. The decision to transfuse was in 23% too restrictive and in 74% too liberal according to the German guidelines. Conclusions Amount of TBSA, length of surgery, and Hb influenced the RBC transfusion rate in burned children. However, age and length of stay were not affected by transfusion of RBCs. In clinical practice of burned children, physicians follow a more liberal transfusion strategy than the proposed in guidelines.

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“…Hypothermia can occur in neonates due to large body surface areas. Coagulopathy can be exacerbated by hypothermia [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Blood Component Transfusion in Tertiary Care Neonatal Intensive Care Unit and Neonatal Intermediate Care Unit: An Audit

Amrutiya¹,

Mungala²,

Patel³

et al. 2020

Cureus

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Background Neonates admitted in a tertiary neonatal intensive care unit (NICU) require multiple blood transfusions because of extended NICU stay and repeated sampling. The rookie organ systems and miniature blood volumes in the neonate call for regular audits in neonatal blood transfusion practice. Sharing component usage data with the blood bank will prepare them to store components according to demand, thus limiting wastage of components as well as make banks ready to face a shortage in case of ramped up requirements. Objective Auditing neonatal blood transfusion indications and identifying the most commonly used component. Methodology This retrospective cohort study was conducted by the department of pediatrics over 22 months from February 20, 2017, to December 30, 2018. Any preterm and term neonates admitted to the NICU and Neonatal Intermediate Care Unit (NIMC) and receiving any transfusion, i.e., fresh frozen plasma (FFP), red cell concentrate (RCC), platelets, and exchange transfusion were included in our study. We collected data from the medical records of NICU and NIMC admitted patients receiving blood component transfusions from 2011 to 2016. Patients were categorized according to the classification of neonatal conditions by the International Classification of Diseases 11th Revision (ICD-11). There were no exclusion criteria. A descriptive statistical analysis was done, and a Chi-square test was applied. Results Out of 340 neonates, 249 (73.2%) were low birth weight, 139 (40.9%) were small for gestational age (SGA), and 277 (81.5%) neonates required transfusion during the first week of life. The majority of neonates require multiple transfusions. Fourteen(4.12%) neonates required up to 10 transfusions, two neonates required up to 22 transfusions, and 58 neonates required more than five blood transfusions. The majority required transfusion due to neonatal sepsis, Disseminated intravascular coagulopathy, low birth weight, respiratory distress syndrome, and unconjugated hyperbilirubinemia. Thirty-seven point eighty-two percent (37.82%) transfusions were fresh frozen plasma, 31.34% transfusions were red cell concentrate, 28.14% transfusions were platelet concentrate, and 2.70% were whole blood. Out of 340 neonates, 317 survived and were discharged. Conclusion The most commonly transfused component was fresh frozen plasma, the indication was neonatal sepsis, and the group was preterm. Whole blood is still being used and needs to be stopped.

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Children are not little adults: blood transfusion in children with burn injury

Cited by 20 publications

References 38 publications

Hypocalcaemia and traumatic coagulopathy: an observational analysis

Hypocalcaemia and traumatic coagulopathy: an observational analysis

Intraoperative transfusion practice in burned children in a university hospital over four years: a retrospective analysis

Blood Component Transfusion in Tertiary Care Neonatal Intensive Care Unit and Neonatal Intermediate Care Unit: An Audit

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