Transfusion Decision Making in Pediatric Critical Illness

Markham, Chris; Small, Sara; Hovmand, Peter S.; Doctor, Allan

doi:10.1016/j.pcl.2017.06.003

Cited by 13 publications

(12 citation statements)

References 180 publications

(68 reference statements)

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“…24 Furthermore, critically ill children transfused for other indications than anemia have worse outcomes than those not transfused with a similar degree of anemia. 26 Most patients (56.7%) received only a single blood transfusion, indicating that acute anemia was the most common reason for blood transfusion, this finding is comparable to reports from Venezuela (86.4%), 27 UK (74%), 23 and USA (69%). 20 Repeated transfusions may increase the risk of alloimmunization, particularly in sickle cell disease and thalassemia patients, therefore extended blood group sub-typing is strongly recommended.…”

Section: Discussionsupporting

confidence: 75%

A Study of Blood Transfusion in Pediatric Patients at a Teaching Hospital, Aden, Yemen

Al-Saqladi¹,

Albanna²

2021

IJCTM

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Background: Blood transfusion is an essential supportive therapy, used over a wide variety of clinical circumstances. Patterns of blood transfusion in pediatric patients are less characterized, and in Yemen information is chronically lacking. This study was aimed to assess the use of blood transfusion in children at a single center in a low resource setting. Materials and Methods: A descriptive, cross-sectional study was conducted on all children (≤16 years) who received blood transfusion in the Pediatric Department, Al-Sadaqa Teaching Hospital, Aden, Yemen over a time period of seven months. Data on age, gender, indications, type of blood product transfused, and adverse reactions were collected. Results: There were 360 transfusion episodes given to 202 patients, at a ratio of 2.3 transfusions per patient. The average age of transfused children was 5.63±4.63 years and 63.4% were male. Children ≤5 years comprised 50% of recipients. Single transfusion was most common (56.7%). Major indications were hemoglobinopathies (43.6%), and oncologic diseases (25.3%). The overall mean of pretransfusion hemoglobin (Hb) was 6.7±2.3 g/dL, varying by primary diagnosis, and the average Hb increment was 1.4 g/dL. The main types of transfused blood were red blood cell concentrates (58.9%) and whole blood (26.4%). Blood group O Rhesus D positive was the most requested (57.5%), followed by A positive (21.9%). Adverse transfusion reactions occurred in 4.4%, including febrile nonhemolytic (56.2%), allergic (37.5%) and transfusionassociated dyspnea (6.3%). Conclusion: Blood transfusion is a frequent supportive therapy in pediatric patients with various medical illnesses in this population. Most common indications were hemoglobinopathies and oncologic diseases. Regular review of blood transfusion is fundamental to ensure better and more rational use of this precious resource.

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Section: Discussionsupporting

confidence: 75%

A Study of Blood Transfusion in Pediatric Patients at a Teaching Hospital, Aden, Yemen

Al-Saqladi¹,

Albanna²

2021

IJCTM

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“…3 The target and trigger for transfusion are influenced by a multitude of factors which include the type of procedure, remaining postoperative cardiac lesions, current physiologic parameters, anticipated physiologic changes, ongoing bleeding, and the age of the patient. 4 A prospective, observational study of pediatric postcardiac surgical patients in 30 North American hospitals revealed that transfusion practices varied greatly among the studied centers and that the transfusion triggers varied between and within acyanotic and cyanotic patient groups. 5 Blood transfusions have been associated with increased risk of infection, length of intensive care unit (ICU) and hospital stay, duration of mechanical ventilation, and mortality in the pediatric population.…”

mentioning

confidence: 99%

Postoperative Hematocrit and Adverse Outcomes in Pediatric Cardiac Surgery Patients: A Cross-Sectional Study From the Society of Thoracic Surgeons and Congenital Cardiac Anesthesia Society Database Collaboration

Long

Engorn

Hill³

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: We sought to examine potential associations between pediatric postcardiac surgical hematocrit values and postoperative complications or mortality. METHODS: A retrospective, cross-sectional study from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and Congenital Cardiac Anesthesia Society Database Module (2014–2019) was completed. Multivariable logistic regression models, adjusting for covariates in the STS-CHSD mortality risk model, were used to assess the relationship between postoperative hematocrit and the primary outcomes of operative mortality or any major complication. Hematocrit was assessed as a continuous variable using linear splines to account for nonlinear relationships with outcomes. Operations after which the oxygen saturation is typically observed to be <92% were classified as cyanotic and ≥92% as acyanotic. RESULTS: In total, 27,462 index operations were included, with 4909 (17.9%) being cyanotic and 22,553 (82.1%) acyanotic. For cyanotic patients, each 5% incremental increase in hematocrit over 42% was associated with a 1.31-fold (95% confidence interval [CI], 1.10-1.55; P = .003) increase in the odds of operative mortality and a 1.22-fold (95% CI, 1.10-1.36; P < .001) increase in the odds of a major complication. For acyanotic patients, each 5% incremental increase in hematocrit >38% was associated with a 1.45-fold (95% CI, 1.28-1.65; P < .001) increase in the odds of operative mortality and a 1.21-fold (95% CI, 1.14-1.29; P < .001) increase in the odds of a major complication. CONCLUSIONS: High hematocrit on arrival to the intensive care unit (ICU) is associated with increased operative mortality and major complications in pediatric patients following cardiac surgery.

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“…In patients for whom no strong recommendation exists (severe PARDS or hemodynamically unstable patients), it would seem best not to base a decision to transfuse solely on Hb level but rather to factor in other clinical and physiological parameters that might indicate low DO 2 , e.g., elevation of lactate level, low central venous oxygenation, or low near infrared spectroscopy (NIRS) level (56). If there is no evidence of low DO 2 , it is likely that a restrictive transfusion strategy is safe.…”

Section: Existing Evidence Regarding Transfusion and Outcome In Children With Pardsmentioning

confidence: 99%

Transfusion in children with acute respiratory distress syndrome

François¹,

Émériaud²,

Karam³

et al. 2019

Ann. Transl. Med.

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Transfusion is a frequent treatment in pediatric patients with acute respiratory distress syndrome (PARDS) although evidence to support transfusion decision-making is lacking. The purpose of this review is to review the current state of knowledge on the issue of transfusion in children with PARDS and to detail the possible beneficial effects and potential deleterious impacts of transfusion in this patient population.Based on the current literature and recent guidelines, a restrictive red blood cell (RBC) transfusion strategy (avoidance of transfusion when the haemoglobin level is above 7 g/dL) is indicated in stable patients without severe PARDS, as these were excluded from the large trials. In children with severe PARDS, further research is needed to determine if factors other than the haemoglobin level might guide RBC transfusion decisionmaking by better characterizing the presence of low oxygen delivery (DO 2 ). Additionally, appropriate indications for prophylactic transfusion of hemostatic products (plasma or platelets) in children with PARDS are lacking.

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Transfusion Decision Making in Pediatric Critical Illness

Cited by 13 publications

References 180 publications

A Study of Blood Transfusion in Pediatric Patients at a Teaching Hospital, Aden, Yemen

A Study of Blood Transfusion in Pediatric Patients at a Teaching Hospital, Aden, Yemen

Postoperative Hematocrit and Adverse Outcomes in Pediatric Cardiac Surgery Patients: A Cross-Sectional Study From the Society of Thoracic Surgeons and Congenital Cardiac Anesthesia Society Database Collaboration

Transfusion in children with acute respiratory distress syndrome

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