Transfusion Reactions in Pediatric Cancer Patients

Abstract

Background: Transfusion is an essential component of supportive management for cancer patients with anemia and thrombocytopenia. It is generally safe; however, it has several risks and complications including those caused by transfusion reactions. This study aimed to describe transfusion reactions in pediatric cancer patients in a tertiary hospital in Indonesia. Methods: This was a descriptive cross-sectional study with a total sampling method. A prospective analysis was performed on episodes of blood transfusion in pediatric patients aged younger than 18 years old with cancer and were hospitalized at the Department of Child Health of the hospital from July to August 2019. After the consent of the parents, the patients were interviewed for various transfusion reactions. Data collected were presented using tables and charts. Results: Leukemia was the most frequent cancer in children cancer patients who need transfusion. Out of 42 children included, 155 episodes of transfusion were observed with 22 episodes showed transfusion reactions (14.2%). The most frequent manifestations were pruritus (31.8%), followed by combination of pruritus and erythema (27.4%) and fever (13.6%). These reactions appeared mostly in 1 to 2 hours (27.2%), with most were mild reactions (59.1%). Conclusion: Transfusion reactions mostly occurred among pediatric patients with cancer in the acute phase with clinical manifestation of allergic reactions, predominantly mild. Early identification of these reactions would result in better treatment and prevention for recurrence of transfusion reactions.

Características transfusionales y hemovigilancia de los pacientes pediátricos con cáncer

“…Furthermore, Bossa et al [11], Freitas et al [14], Pedrosa et al [24], and Guo et al [26] agree that immediate reactions are predominant and that late reactions are infrequent, with allergic reactions and RTFNH prevailing; these effects occur because the immune system of cancer patients is depressed and unable to reject the antigen from transfusion. Now, from the unwanted impacts resulting in our study, the majority of the adverse effects were mild and entirely treated with medications (mainly steroids), similar to the findings of Jati et al [13], Pedrosa et al [24],…”

“…On the other hand, the present investigation reported that approximately half of the transfusions involved RBC, followed by apheresis, similar to the findings of Alcayed et al [15]. Pedrosa et al [19] contrast with those of Jati et al [13] and Kohorst et al [18], who concluded that more than 50% of patients were transfused with PC. This depends on the degree of myelosuppression and condition of the cell lines, as well as the complications and comorbidities present, such as hemorrhages, surgical pathologies, and sepsis.…”

“…patients and 620 transfusions, and we showed that the majority of the individuals in the transfusion population were adolescents and that the men suffered from B-ALL and were in the induction phase. In addition, more than half of the patients had a history of transfusion, which agrees with the results of Jati et al [13] and Freitas et al [14]. Epidemiologically, this occurs because after the age of 15, cancer is 2.7 times more common, and men are more susceptible to developing oncological pathologies from their genetic basis.…”

“…This peculiarity is because both erythrocytes and platelet concentrates can contain leukocytes and proinflammatory cytokines that trigger reactions; as we observed, most transfusions were performed with RBCs and apheresis (they contain platelets). In addition, the results indicated that approximately 30% of patients with B-ALL developed ATRs, which was also observed in the studies of Jati et al [13] and Guo et al [25] and may be secondary to greater exposure. to transfusions, as well as the leukocytes and cytokines of the transfused blood components.…”