Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Valentine, Stacey L.; Bembea, Melania M.; Muszynski, Jennifer A.; Cholette, Jill M.; Doctor, Allan; Spinella, Philip C.; Steiner, Marie; Tucci, Marisa; Hassan, Nabil; Parker, Robert I.; Lacroix, Jacques; Argent, Andrew C.; Carson, Jeffrey L.; Remy, Kenneth E.; Demaret, Pierre; Émériaud, Guillaume; Kneyber, Martin C. J.; Guzzetta, Nina A.; Hall, Mark W.; MacRae, Duncan; Karam, Oliver; Russell, Robert T.; Stricker, Paul A.; Vogel, Adam M.; Tasker, Robert C.; Turgeon, Alexis F.; Schwartz, Steven M.; Willems, Ariane; Josephson, Cassandra D.; Luban, Naomi L.C.; Lehmann, Leslie; Stanworth, Simon; Zantek, Nicole D.; Bunchman, Timothy E.; Cheifetz, Ira M.; Fortenberry, James D.; Delaney, Meghan; Watering, Leo M. van de; Robinson, Karen A.; Malone, Sara; Steffen, Katherine; Bateman, Scot T.

doi:10.1097/pcc.0000000000001613

Cited by 143 publications

(96 citation statements)

References 50 publications

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“…Donor exposure is another relevant issue, especially when it comes to the smallest and sickest premature infants, requiring multiple transfusions in the early days of life. The use of satellite bags (small-volume aliquots from the same unit of donor blood) may limit the donor exposure rate [115,116].…”

Section: Rbc Transfusionsmentioning

confidence: 99%

Iron Homeostasis Disruption and Oxidative Stress in Preterm Newborns

et al. 2020

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Iron is an essential micronutrient for early development, being involved in several cellular processes and playing a significant role in neurodevelopment. Prematurity may impact on iron homeostasis in different ways. On the one hand, more than half of preterm infants develop iron deficiency (ID)/ID anemia (IDA), due to the shorter duration of pregnancy, early postnatal growth, insufficient erythropoiesis, and phlebotomy losses. On the other hand, the sickest patients are exposed to erythrocytes transfusions, increasing the risk of iron overload under conditions of impaired antioxidant capacity. Prevention of iron shortage through placental transfusion, blood-sparing practices for laboratory assessments, and iron supplementation is the first frontier in the management of anemia in preterm infants. The American Academy of Pediatrics recommends the administration of 2 mg/kg/day of oral elemental iron to human milk-fed preterm infants from one month of age to prevent ID. To date, there is no consensus on the type of iron preparations, dosages, or starting time of administration to meet optimal cost-efficacy and safety measures. We will identify the main determinants of iron homeostasis in premature infants, elaborate on iron-mediated redox unbalance, and highlight areas for further research to tailor the management of iron metabolism.

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Section: Rbc Transfusionsmentioning

confidence: 99%

Iron Homeostasis Disruption and Oxidative Stress in Preterm Newborns

et al. 2020

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“…In 2018, the Pediatric Critical Care Transfusion and Anemia expertise Initiative (TAXI) published good practice guidelines and recommendations for the use of RBC transfusions. The guidelines supported Lacroix's restrictive transfusion threshold of 7 g/dl in hemodynamically stable patients and urged clinicians to regard the need for transfusion in the context of the patient's broader clinical picture rather than simply looking at a threshold number (54,56,57).…”

Section: Transfusion Of Blood Productsmentioning

confidence: 99%

Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation

et al. 2020

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“…Current expert consensus guidelines recommend taking into consideration the individual patient's clinical status along with an optimum hemoglobin target. In general, recommendations for pediatric patients (excluding neonates) suggests that a hemoglobin threshold transfusion target of 7 g/dL (70 g/L) is appropriate in a hemodynamically stable well compensated patient and that, , in general, given a hemoglobin concentration of >9 g/dL (90 g/L), red blood transfusion is unnecessary and inappropriate . Neonates, are physiologically quite distinct from infants and young children and require a specific and different set of hemoglobin thresholds and transfusion guidelines .…”

Section: Standard 13 Guidence Patient Blood Management For Pediatricmentioning

confidence: 99%

Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version)

Goobie¹,

Gallagher²,

Gross

et al. 2019

Pediatric Anesthesia

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Summary Patient Blood Management is the timely application of evidence‐based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Conceptually similar to a “bundle” strategy, it is designed to improve clinical care using comprehensive evidence‐based treatment strategies to manage patients with potential or ongoing critical bleeding, bleeding diathesis, critical anemia, and/ or a coagulopathy. Patient Blood Management includes multimodal strategies to screen, diagnose and properly treat anemia, coagulopathies and minimize bleeding, using goal‐directed therapy and leverages a patient's physiologic ability to adapt to anemia while definitive treatment is undertaken. Allogeneic blood component transfusion is one traditional therapeutic modality out of many for managing blood loss and anemia and, while it may be the best choice in certain situations, other effective and more appropriate options are available and should be used in conjunction or alone. Therefore, comprehensive Patient Blood Management is the new standard of care to prevent and manage anemia and optimize hemostasis and has been recommended by the World Health Organization, the American Society of Anesthesiologists, the European Society of Anaesthesiology and the Australian National Blood Authority. While there is a plethora of expert consensus and good practice guidelines published for blood component transfusion from multiple professional organizations and societies, there remains a need for more comprehensive and broader standards of patient medical management to proactively reduce the risk of exposure to allogeneic transfusions. In 2010, the Society for Advancement of Blood Management published the first comprehensive standards to address the administrative and clinical components of an effective, patient‐centered Patient Blood Management program. Recognizing the need to reduce inappropriate transfusions, some professional organizations have placed their emphasis on transfusion guidelines. In contrast, the focus of the Society for Advancement of Blood Management Standard is on the centrality of the patient and the full spectrum of therapeutic strategies needed to improve clinical outcomes in patients at risk for blood loss or anemia, thereby reducing avoidable transfusions as well. The Standards are meant not to replace, but to complement transfusion guidelines by more completely addressing the need for a multi‐modal clinical approach with the goal to improve patient outcomes. Compared to adult programs, Pediatric Patient Blood Management programs are currently not commonly accepted as standard of care for pediatric patients. This is partly due to the fact that, until recently, there was a paucity of robust evidence‐based literature and expert consensus guidelines on pediatric PBM. Managing pediatric bleeding and blood product transfusion presents a unique set of challenges. The main goal of transfusion is to correct or avoid imminent inadequate oxygen c...

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Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Abstract: The Transfusion and Anemia Expertise Initiative recommendations provide important clinical guidance and applicable tools to avoid unnecessary RBC transfusions. Research recommendations identify areas of focus for future investigation to improve outcomes and safety for RBC transfusion.

Cited by 143 publications

References 50 publications

Iron Homeostasis Disruption and Oxidative Stress in Preterm Newborns

Iron Homeostasis Disruption and Oxidative Stress in Preterm Newborns

Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation

Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version)

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