Research Priorities for Plasma and Platelet Transfusion Strategies in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

Abstract

To present a list of high-priority research initiatives for the study of plasma and platelet transfusions in critically ill children from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding.DESIGN: Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children. SETTING: Not applicable.PATIENTS: Critically ill pediatric patients at risk of bleeding and receiving plasma and/or platelet transfusions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:A panel of 13 experts developed research priorities for the study of plasma and platelet transfusions in critically ill children which were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. The specific priorities focused on the following subpopulations: severe trauma, traumatic brain injury, intracranial hemorrhage, cardiopulmonary bypass surgery, extracorporeal membrane oxygenation, oncologic diagnosis or stem cell transplantation, acute liver failure and/or liver transplantation, noncardiac surgery, invasive procedures outside of the operating room, and sepsis and/or disseminated intravascular coagulation. In addition, tests to guide plasma and platelet transfusion, as well as component selection and processing, were addressed. We developed four general overarching themes and 14 specific research priorities using modified Research and

What Laboratory Tests and Physiologic Triggers Should Guide the Decision to Administer a Platelet or Plasma Transfusion in Critically Ill Children and What Product Attributes Are Optimal to Guide Specific Product Selection? From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

“…This systematic review and assessment of the literature has yielded a robust set of two recommendations and five expert consensus statements that describe the current state of evidence-based practice of laboratory testing and blood products attributes for platelet and plasma transfusions for critically ill children. Further research, particularly to investigate appropriate laboratory variables that correlate bleeding risks to guide transfusion therapy, is urgently needed and discussed in the companion TAXI-CAB research gaps article (62).…”

Transfusion Strategies for Hemostatic Blood Products in Critically Ill Children: A Narrative Review and Update on Expert Consensus Guidelines

“…Areas in need for future research include studies that weigh the risk/benefit ratio in tolerating a coagulation abnormality or thrombocytopenia versus the risk/benefit ratio of giving a plasma or platelet transfusion in critically ill children, and studies that seek to determine the optimal dose, timing, and order in which plasma and platelet transfusions are administered, with respect to each other and to other hemostatic interventions to decrease the risk of bleeding or stop active bleeding in critically ill children. 44 E…”

“…5,11–17 Recently, TAXI-CAB presented evidence-based recommendations and, when evidence was lacking, expert-based recommendations for plasma and platelet transfusion in critically ill children across clinical scenarios including: (1) severe trauma, intracranial hemorrhage (ICH), or traumatic brain injury (TBI), (2) CPB, (3) ECMO, (4) oncologic diagnosis or hematopoietic stem cell transplantation, (5) acute liver failure or liver transplantation, (6) noncardiac surgery, (7) invasive procedures outside the operating room (OR), (8) sepsis and/or disseminated intravascular coagulation (DIC), and laboratory assays and selection/processing of plasma and platelet components. 5,39–44 Clinical decision trees were created to guide transfusion decision-making of plasma and platelets, shown in Figure 1 (plasma) and Figure 2 (platelets). 44 Overall, the group noted insufficient evidence to guide many recommendations, presented expert consensus, and highlighted areas for ongoing investigation.…”

“…5,39–44 Clinical decision trees were created to guide transfusion decision-making of plasma and platelets, shown in Figure 1 (plasma) and Figure 2 (platelets). 44 Overall, the group noted insufficient evidence to guide many recommendations, presented expert consensus, and highlighted areas for ongoing investigation. 44…”

“…44 Overall, the group noted insufficient evidence to guide many recommendations, presented expert consensus, and highlighted areas for ongoing investigation. 44…”