Pediatric non-red cell blood product transfusion practices: what's the evidence to guide transfusion of the ‘yellow’ blood products?

Abstract

Purpose of review Research studies pertaining to the management of pediatric non-red cell blood product transfusion is limited. Clinical practices vary within disciplines and regions. Anesthesiologists need evidence-based guidelines to make appropriate and safe decisions regarding transfusion of the ‘yellow’ blood products for pediatric patients. Recent findings This review outlines clinical indications for transfusion of fresh frozen plasma, cryoprecipitate, platelets, and fibrinogen concentrate in pediatrics. Recent studies of non-red blood cell transfusions in critical, but stable situations are highlighted. Recommendations to guide transfusion of the ‘yellow’ blood products in operative and non-operative settings are summarized. Special attention is drawn to guidelines in massive hemorrhage and trauma situations. Summary Evidence-based guidelines and expert consensus recommendations exist to guide the transfusion of pediatric non-red blood products and should be followed when transfusing the ‘yellow’ blood components. As high-quality studies in neonates, infants and children are limited, future research should broaden our knowledge in this direction with the goal to use restrictive strategies to improve patient outcomes.

Diagnostic Scores and Treatment Options for Acute Disseminated Intravascular Coagulation in Children

“…The commonly used blood components in DIC treatment include platelets, fresh frozen plasma (FFP), cryoprecipitate, and fibrinogen concentrates. However, since DIC is a procoagulant process, they should not primarily be administered based on laboratory results but should be administered only in patients with bleeding manifestations [2,[14][15][16].…”

“…However, it should be used judiciously as PCC can cause thrombosis and lacks certain coagulation factors (especially factor V) while in DIC, there is a global deficiency of coagulation factors [1,2]. To date, there is no evidence-based data on efficacy, safety, and optimal dosing of PCC in the pediatric population [16].…”

“…Severe hypofibrinogenemia (value less than 1.5 g/l with bleeding or less than 1 g/l that persists despite FFP replacement) may be treated with fibrinogen concentrate or cryoprecipitate [1,16]. Although there is a lack of clear evidence, the two may be considered equivocal alternatives.…”

“…Although there is a lack of clear evidence, the two may be considered equivocal alternatives. The recommended dose of fibrinogen concentrate is 50 ml/kg, and that of cryoprecipitate is 5-10 ml/kg [16,19]. Cryoprecipitate contains factor VIII, factor XIII, von Willebrand factor, fibrinogen, and fibronectin [19].…”

Neonatal and pediatric blood bank practice in the United States: Results from the AABB pediatric transfusion medicine subsection survey

“…The practice of ABO matching of platelet transfusions in blood banks is variable, and consensus guidelines are lacking 29,30 . Hemolysis has historically been the concern with providing platelet transfusions with incompatible plasma, particularly in children with small blood volumes; however, a more recent study indicates higher rates of transfusion reactions in general compared to ABO compatible transfusions 31,32 .…”