Transfusion Reactions in Pediatric Patients: An Analysis of 5 Years of Hemovigilance Data From a National Center for Children's Health in China

Guo, Kai; Wang, Xiaohuan; Zhang, Huimin; Wang, Mengjian; Song, Shanshan; S.K., Edmond

doi:10.3389/fped.2021.660297

Cited by 6 publications

(5 citation statements)

References 36 publications

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“…Of these, 77 were included. Through handsearching, we also found three additional reports and/or articles that were eligible for inclusion, 22–24 making a total of 80 studies for the final meta‐analysis 25–96 . The UK's Serious Hazards of Transfusion (SHOT) issues annual reports of transfusion‐related adverse events, and we were able to include data from 2003 to 2022, with the exception of 2009 in which the Supplementary Tables were not available for that year.…”

Section: Resultsmentioning

confidence: 99%

The incidence of transfusion‐related acute lung injury using active surveillance: A systematic review and meta‐analysis

White,

Walker,

Schmidt

et al. 2023

Transfusion

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BackgroundTransfusion‐related acute lung injury (TRALI) is a leading cause of transfusion‐related mortality. A concern with passive surveillance to detect transfusion reactions is underreporting. Our aim was to obtain evidence‐based estimates of TRALI incidence using meta‐analysis of active surveillance studies and to compare these estimates with passive surveillance.Study Design and MethodsWe performed a systematic review and meta‐analysis of studies reporting TRALI rates. A search of Medline and Embase by a research librarian identified studies published between January 1, 1991 and January 20, 2023. Prospective and retrospective observational studies reporting TRALI by blood component (red blood cells [RBCs], platelets, or plasma) were identified and all inpatient and outpatient settings were eligible. Adult and pediatric, as well as general and specific clinical populations, were included. Platelets and plasma must have used at least one modern TRALI donor risk mitigation strategy. A random effects model estimated TRALI incidence by blood component for active and passive surveillance studies and heterogeneity was examined using meta‐regression.ResultsEighty studies were included with approximately 176‐million blood components transfused. RBCs had the highest number of studies (n = 66) included, followed by platelets (n = 35) and plasma (n = 34). Pooled TRALI estimates for active surveillance studies were 0.17/10,000 (95% confidence intervals [CI]: 0.03–0.43; I2 = 79%) for RBCs, 0.31/10,000 (95% CI: 0.22–0.42; I2 = <1%) for platelets, and 3.19/10,000 (95% CI: 0.09–10.66; I2 = 86%) for plasma. Studies using passive surveillance ranged from 0.02 to 0.10/10,000 among the various blood components.DiscussionIn summary, these estimates may improve a quantitative understanding of TRALI risk, which is important for clinical decision‐making weighing the risks and benefits of transfusion.

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Section: Resultsmentioning

confidence: 99%

The incidence of transfusion‐related acute lung injury using active surveillance: A systematic review and meta‐analysis

White,

Walker,

Schmidt

et al. 2023

Transfusion

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“…15 A study conducted in China showed 1.35% of transfusion reactions in children over a period of five years, out of which main types of reaction were allergic and febrile non-hemolytic transfusion reactions. 16 Moreover, there are studies which show that RBC transfusion in critically ill children is associated with non-favorable outcomes. 17 Periodic clinical audits are an efficient tool to self-regulate the transfusion practices and avoid unnecessary use of blood products, hazard to patients and waste of resources.…”

Section: Discussionmentioning

confidence: 99%

Blood product transfusion practices in pediatric critically ill patients at a tertiary care hospital, Pakistan

et al. 2023

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Objective: To determine the frequency of inappropriate blood product transfusions in pediatric critically ill patients. Methods: We collected data for this descriptive study from January to December 2020 at the Pediatric Intensive Care Unit (PICU) of Dr. RKMP Civil Hospital, Karachi. We included all patients one month to 12 years of age, admitted to pediatric intensive care unit and received any blood product transfusion. We reviewed their medical records and noted the demographic and clinical variables, type of blood product transfused with its indication and determined whether transfusion was appropriate or not, as per the standard guidelines and consensus recommendations. Results: Number of patients who were transfused was n=39, out of which females were 51.3%. Mean age of the patients was 49.0 months ±50.9 months. Total number of transfusions done were n=135, with most common blood product transfused being Fresh Frozen plasma (FFP) in 44.4%. A total of n=117 (86.66%) transfusion were appropriate as per the standard guidelines, while 18 (13.33%) were inappropriate (P-value <0.5). The most common indication of FFP transfusion was INR>2.0 in 51.6%, for Packed red cell transfusion was hemoglobin between 5 and 7 gm/dl in 35.5% and for Platelets was <20,000 with risk of bleeding in 36.6%. Conclusion: This study highlights the occurrence of inappropriate transfusions in critically ill pediatric patients. We need to reinforce the knowledge of our health care workers and display the guidelines in intensive care units. doi: https://doi.org/10.12669/pjms.39.4.7503 How to cite this: Rafique M, Nasir S, Kamran A, Jamal A. Blood product transfusion practices in pediatric critically ill patients at a tertiary care hospital, Pakistan. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7503 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…60 Platelet transfusion threshold recommendations to prevent bleeding in this population range from 100 000 to 130 000/ μl. 55,56 Neonates on ECMO are at high-risk of bleeding due to heparinization, along with thrombocytopenia and/or platelet dysfunction.…”

Section: Term Neonatesmentioning

confidence: 99%

“…A caveat to the findings of these studies are its relatively smaller sample size. A recent retrospective observational study by Guo et al, has mentioned that transfusion reactions among children were most commonly associated with platelets and mostly it was allergic transfusion reactions followed by febrile non‐haemolytic transfusion reactions 56 . Therefore, decisions about platelet transfusion should be judicious and evidence‐based.…”

Section: Evidence‐based Hemotherapymentioning

confidence: 99%

“…Among neonates with hypoxic–ischemic encephalopathy, bleeding occurred in 28%, with 21% of those transfused receiving platelet transfusions 60 . Platelet transfusion threshold recommendations to prevent bleeding in this population range from 100 000 to 130 000/μl 55,56 . Neonates on ECMO are at high‐risk of bleeding due to heparinization, along with thrombocytopenia and/or platelet dysfunction.…”

Section: Evidence‐based Hemotherapymentioning

confidence: 99%

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Transfusion therapy of neonatal and paediatric patients: They are not just little adults

Gammon

Al‐Mozain

Aurón

et al. 2022

Transfusion Medicine

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Patient blood management (PBM) strategies are needed in the neonate and paediatric population, given that haemoglobin thresholds used are often higher than recommended by evidence, with exposure of children to potential complications without meaningful benefit. A literature review was performed on the following topics: evidence-based transfusions of blood components and pharmaceutical agents. Other topics reviewed included perioperative coagulation assessment and perioperative PBM. The Transfusion and Anaemia Expertise Initiative (TAXI) consortium published a consensus statement addressing haemoglobin (Hb) transfusion threshold in multiple subsets of patients. A multicentre trial (PlaNeT-2) reported a higher risk of bleeding and death or serious new bleeding among infants who received platelet transfusion at a higher (50 000/μl) compared to a lower (25 000/μl) threshold. Recent data support the use of a restrictive transfusion threshold of 25 000/μl for prophylactic platelet transfusions in preterm neonates. The TAXI-CAB consortium mentioned that in critically ill paediatric patients undergoing invasive procedures outside of the operating room, platelet transfusion might be considered when the platelet count is less than or equal to 20 000/μl and there is no benefit of platelet transfusion when the platelet count is more than 50 000/μl. There are limited controlled studies in paediatric and neonatal population regarding plasma transfusion. Blood conservation strategies to minimise allogenic blood exposure are essential to positive patient outcomes neonatal and paediatric transfusion practices have changed significantly in recent years since randomised controlled trials were published to guide practice. Additional studies are needed in order to provide practice change recommendations.

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Transfusion Reactions in Pediatric Patients: An Analysis of 5 Years of Hemovigilance Data From a National Center for Children's Health in China

Cited by 6 publications

References 36 publications

The incidence of transfusion‐related acute lung injury using active surveillance: A systematic review and meta‐analysis

The incidence of transfusion‐related acute lung injury using active surveillance: A systematic review and meta‐analysis

Blood product transfusion practices in pediatric critically ill patients at a tertiary care hospital, Pakistan

Transfusion therapy of neonatal and paediatric patients: They are not just little adults

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