1
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Soutar R, McSporran W, Tomlinson T, Booth C, Grey S. Guideline on the investigation and management of acute transfusion reactions. Br J Haematol 2023; 201:832-844. [PMID: 37211954 DOI: 10.1111/bjh.18789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Richard Soutar
- Garnavel General Hospital NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | - Catherine Booth
- NHS Blood and Transplant, London, UK
- Barts Health NHS Trust, London, UK
| | - Sharran Grey
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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2
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Lieberman L, Karam O, Stanworth SJ, Goobie SM, Crighton G, Goel R, Lacroix J, Nellis ME, Parker RI, Steffen K, Stricker P, Valentine SL, Steiner ME. Plasma and Platelet Transfusion Strategies in Critically Ill Children With Malignancy, Acute Liver Failure and/or Liver Transplantation, or Sepsis: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding. Pediatr Crit Care Med 2022; 23:e37-e49. [PMID: 34989704 PMCID: PMC8769367 DOI: 10.1097/pcc.0000000000002857] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To present the consensus statements with supporting literature for plasma and platelet transfusions in critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation 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 neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A panel of 13 experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed 12 expert consensus statements. CONCLUSIONS In the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding program, the current absence of evidence for use of plasma and/or platelet transfusion in critically ill children with malignancy, acute liver disease and/or following liver transplantation, and sepsis means that only expert consensus statements are possible for these areas of practice.
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Affiliation(s)
- Lani Lieberman
- Department of Clinical Pathology, University Health Network Hospitals. Department of Laboratory Medicine & Pathobiology; University of Toronto, Toronto, Canada
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA, USA
| | - Simon J. Stanworth
- NHS Blood and Transplant; Oxford University Hospitals NHS Foundation Trust; Radcliffe Department of Medicine and Oxford BRC Haematology Theme, University of Oxford, UK
| | - Susan M. Goobie
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gemma Crighton
- Department of Haematology, Royal Children’s Hospital, Melbourne, Australia
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD and Simmons Cancer Institute, Division of Hematology Oncology at SIU School of Medicine, Springfield, IL, USA
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, QC, Canada
| | - Marianne E. Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital – Weill Cornell Medicine, New York, NY, USA
| | - Robert I. Parker
- Department of Pediatric Hematology/Oncology, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Katherine Steffen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Paul Stricker
- Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, PA, USA
| | - Stacey L. Valentine
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Marie E. Steiner
- Divisions of Hematology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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3
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Tucci M, Crighton G, Goobie SM, Russell RT, Parker RI, Haas T, Nellis ME, Vogel AM, Lacroix J, Stricker PA. Plasma and Platelet Transfusion Strategies in Critically Ill Children Following Noncardiac Surgery and Critically Ill Children Undergoing Invasive Procedures Outside the Operating Room: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding. Pediatr Crit Care Med 2022; 23:e50-e62. [PMID: 34989705 PMCID: PMC8769350 DOI: 10.1097/pcc.0000000000002858] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To present consensus statements and supporting literature for plasma and platelet transfusions in critically ill children following noncardiac surgery and critically ill children undergoing invasive procedures outside the operating room 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 children undergoing invasive procedures outside of the operating room or noncardiac surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A panel of 10 experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill children following noncardiac surgery or undergoing invasive procedures outside of the operating room. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed eight expert consensus statements focused on the critically ill child following noncardiac surgery and 10 expert consensus statements on the critically ill child undergoing invasive procedures outside the operating room. CONCLUSIONS Evidence regarding plasma and platelet transfusion in critically ill children in this area is very limited. The Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding Consensus Conference developed 18 pediatric specific consensus statements regarding plasma and platelet transfusion management in these critically ill pediatric populations.
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Affiliation(s)
- Marisa Tucci
- Department of Pediatrics, Sainte-Justine University Hospital, University of Montreal, Montreal, QC, Canada
| | - Gemma Crighton
- Department of Haematology, Royal Children’s Hospital, Melbourne, Australia
| | - Susan M. Goobie
- Boston Children’s Hospital, Dept. of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Boston, USA
| | - Robert T. Russell
- Department of Surgery, Division of Pediatric Surgery, Children’s of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert I. Parker
- Department of Pediatrics, Stony Brook University, Stony Brook, NY
| | - Thorsten Haas
- Department of Anesthesia, Zurich University Children’s Hospital, Zurich, Switzerland
| | - Marianne E. Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital – Weill Cornell Medicine, New York, NY, USA
| | - Adam M. Vogel
- Division of Pediatric Surgery, Surgery and Pediatrics Baylor College of Medicine Texas Children’s Hospital, Houston, Texas
| | - Jacques Lacroix
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Paul A. Stricker
- Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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4
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Hasan M, Lal J, Ali N. Frequency and types of transfusion reactions in pediatric population: A report from a tertiary care center in Pakistan. IRAQI JOURNAL OF HEMATOLOGY 2022. [DOI: 10.4103/ijh.ijh_47_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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5
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Yanagisawa R. Preventing adverse reactions in pediatric transfusions using washed platelet concentrate. Pediatr Int 2021; 63:391-403. [PMID: 33290634 DOI: 10.1111/ped.14572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/02/2020] [Indexed: 01/04/2023]
Abstract
Blood transfusion is an important form of supportive care in children; however, transfusion-associated adverse reactions (TARs) are a problem. As with adults, allergic transfusion reactions (ATRs) and febrile non-hemolytic transfusion reactions (FNHTRs) are major TARs, and the frequency of ATRs caused by platelet concentrate (PC) tends to be particularly high. The plasma component of the blood product is thought to be a major factor in the onset of TARs such as ATR and FNHTR. By contrast, in children, age, underlying disease, and number of blood transfusions may be relevant patient-related factors. Although acetaminophen or diphenhydramine may be used prophylactically to prevent TARs, there is no clear evidence of their effectiveness. Volume-reduced PC is used to prevent TARs; however, it may be difficult to maintain the quality of platelets. Plasma-replaced PC stored with platelet additive solution raises the concern that TARs cannot be completely prevented by residual plasma. Washed PC removes most of the plasma, so it can effectively prevent ATR and FNHTR. The recent development of platelet additive solution [M-sol, bicarbonate Ringer's solution supplemented with acid-citrate-dextrose formula A (BRS-A)] in Japan has enabled the maintenance of the quality of platelets for long periods. The clinical use of washed PC in Japan has therefore progressed. Washed PC with M-sol or BRS-A for pediatric patients can effectively prevent TARs without diminishing the transfusion effect. The supply of washed PC has begun from the Japanese Red Cross Society, and it has become possible to use washed PC at all medical institutions in Japan.
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Affiliation(s)
- Ryu Yanagisawa
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan.,Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan
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6
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Al-Saqladi AWM, Albanna TA. A Study of Blood Transfusion in Pediatric Patients at a Teaching Hospital, Aden, Yemen. INTERNATIONAL JOURNAL OF CLINICAL TRANSFUSION MEDICINE 2021. [DOI: 10.2147/ijctm.s293720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Transfusion Strategies for Pediatric Cardiac Surgery: A Meta-Analysis and Trial Sequential Analysis. Pediatr Cardiol 2021; 42:1241-1251. [PMID: 34050374 PMCID: PMC8162158 DOI: 10.1007/s00246-021-02644-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/19/2021] [Indexed: 02/08/2023]
Abstract
This study aimed to compare the effects of restrictive and liberal red blood cell (RBC) transfusion strategies on pediatric patients undergoing cardiac surgery, including cyanotic and non-cyanotic children. A literature search of the MEDLINE, EMBASE, PubMed, and the Cochrane Library database was conducted. Meta-analyses were carried out comparing restrictive and liberal transfusion strategies. Subgroup analyses were performed based on the basis of cyanotic status. Five randomized controlled trials with a total of 497 children were included. There was no significant difference in the risk of in-hospital mortality between the two transfusion strategies (risk ratio 1.21; 95% confidence interval 0.49 to 2.99; P = 0.68). The trial sequential analysis suggested that the current meta-analysis had an absence of evidence for in-hospital mortality, and the data were insufficient. Moreover, no significant differences existed between groups in terms of risk of infection, blood loss, duration of mechanical ventilation, pediatric intensive care unit (PICU) stay duration, or hospital stay duration. Cyanotic children treated with a liberal transfusion strategy had a shorter ventilator duration, but the transfusion strategy did not affect in-hospital mortality, infection, hospital stay, or PICU stay duration. On the basis of the available data, our analysis indicates that a liberal transfusion strategy did not lead to a better outcomes, but the data are extremely sparse, which highlights the need for clearer transfusion guidelines specific to this specific population.Trial registration number CRD42018102283.
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Guo K, Wang X, Zhang H, Wang M, Song S, Ma S. Transfusion Reactions in Pediatric Patients: An Analysis of 5 Years of Hemovigilance Data From a National Center for Children's Health in China. Front Pediatr 2021; 9:660297. [PMID: 34123967 PMCID: PMC8193363 DOI: 10.3389/fped.2021.660297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to describe transfusion reactions of pediatric patients from a National Center for Children's Health in China and to examine reaction incidents, reaction types by blood transfusion, and the associated blood products resulting in transfusion reactions. Methods: We compared transfusion reaction rates, among platelets, plasma, and red blood cells (RBCs) using a retrospective analysis of pediatric patients treated with blood transfusion based on data from the National Center for Children's Health (Beijing, China) by a hemovigilance reporting system from January 2015 to December 2019. Results: Over the past 5 years, 165 reactions were reported, and the overall incidence was 1.35‰ (95% CI: 1.14-1.55‰; 165/122,652); for each separate year, the incidences were 1.25‰ (95% CI: 0.76-1.74‰; 25/20,035; 2015), 1.09‰ (95% CI: 0.65-1.52‰; 24/22,084; 2016), 1.66‰ (95% CI: 1.14-2.18‰; 39/23,483; 2017), 1.36‰ (95% CI: 0.92-1.81‰; 36/26,440; 2018) and 1.34‰ (95% CI: 0.93-1.75‰; 41/30,610; 2019). Transfusion reaction incidents by person included 0.37‰ (95% CI: 0.21-0.53‰; 21/56,815) RBCs, 2.98‰ (95% CI: 2.33-3.64‰; 79/26,496) platelets and 1.65‰ (95% CI: 1.25-2.05‰; 65/39,341) frozen plasma. According to the analysis by blood products, the incidence of transfusion was 0.34‰ (95% CI: 0.20-0.48‰; 23/66,958) for RBCs, 3.21‰ (95% CI: 2.50-3.92‰; 78/24,318.5) for platelets, and 0.94‰ (95% CI: 0.71-1.17‰; 64/67,912) for frozen plasma. Transfusion reactions were most commonly associated with platelets, followed by plasma and RBC transfusions. The types of blood transfusion reactions were mainly allergic reactions (86.67%) and febrile non-hemolytic transfusion reactions (FNHTRs, 4.24%). The disease types of pediatric patients with transfusion reactions were concentrated among those with blood system diseases. A total of 80.61% of children with transfusion reactions had a previous blood transfusion history. Conclusions: Transfusion reactions are still relatively common in pediatric patients, and additional studies are necessary to address the differences in reaction rates, especially allergic and FNHTRs. Robust hemovigilance systems do include a special section dedicated to children will further the understanding of these reactions and trends, and prospective randomized clinical controlled trials may need to be conducted to perform preventive and corrective measures.
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Affiliation(s)
- Kai Guo
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaohuan Wang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Huimin Zhang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Mengjian Wang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shanshan Song
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuxuan Ma
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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9
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Pediatric Hemovigilance and Adverse Transfusion Reactions. Clin Lab Med 2020; 41:51-67. [PMID: 33494885 DOI: 10.1016/j.cll.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Some types of transfusion reactions occur more frequently in the pediatric than the adult population. Allergic reactions are the most common, followed by nonhemolytic transfusion reactions; male children seem most susceptible to such reactions. Platelets are often implicated and pulmonary reactions are understudied in children. Clinical sequelae in neonates, such as bronchopulmonary dysplasia/chronic lung disease and intraventricular hemorrhage, have received increasing attention in relation to transfusion. There is a need to better understand the pathophysiology of transfusion reactions in neonatal and pediatric populations so preventive strategies can be undertaken. There is also a need for robust hemovigilance systems.
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10
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Zheng Y, Pei D, Sweat L, Ryan M, Mestemacher MA, Gann M, Cheng C, Geiger TL. Contribution of donor- and recipient-associated factors to allergic transfusion reactions to platelets. Transfusion 2020; 61:744-753. [PMID: 33314235 DOI: 10.1111/trf.16221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric hematology-oncology patients require frequent platelet transfusions to manage chemotherapy-induced thrombocytopenia, and allergic transfusion reactions (ATRs) are common. Risk for platelet-associated ATRs can result from recipient- or donor-specific factors. STUDY DESIGN AND METHODS We report a rare case in which an individual platelet donor caused repeated ATRs in multiple recipients. This observation led us to conduct a retrospective study at a pediatric hematology-oncology center to identify donor- and recipient-associated risk factors for ATRs. RESULTS Single-donor platelets from an individual donor precipitated ATRs in 78.6% (n = 11/14) of recipients and 66.7% (n = 12/18) of platelet transfusions. We found in a cohort of pediatric hematology-oncology patients that 12.6% of recipients and 1.0% of platelet transfusions were associated with ATRs. Recipients who were aged 4 to 18 years, male, and those with central nervous system or solid tumors and with a history of ATRs to platelets were more likely to experience ATRs. Donor-associated risk factors were not identified, and we did not implicate additional donors in our single-center cohort with a frequency of ATRs comparable to the index donor. Based on our findings, we developed a novel statistical model to identify recipients and donors prone to experiencing or mediating ATRs. CONCLUSIONS Both donors and recipients contribute to ATRs. Identification of high-risk donors and recipients for further scrutiny and potential interventions can improve the safety of platelet transfusions.
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Affiliation(s)
- Yan Zheng
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lori Sweat
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Missy Ryan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Mark A Mestemacher
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Maria Gann
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Terrence L Geiger
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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11
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Yamanaka M, Yanagisawa R, Kojima S, Nakazawa H, Shimodaira S. Investigation of factors associated with allergic transfusion reaction due to platelet transfusion and the efficacy of platelets resuspended in BRS-A in adult patients. Transfusion 2019; 59:3405-3412. [PMID: 31532542 DOI: 10.1111/trf.15527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although allergic transfusion reactions (ATRs) resulting from platelet concentrate (PC) are a common adverse reaction, the mechanism underlying ATRs has not been fully elucidated. Plasma-replaced PC suspended in bicarbonate Ringer's solution and anticoagulant citrate dextrose solution A (RPC-B) is effective for preventing ATRs in children in Japan; however, there is not enough evidence in adult populations. STUDY DESIGN AND METHODS We conducted a retrospective analysis focused on factors associated with ATRs developing from PC transfusions in adult patients in a single institution between 2015 and 2018. The clinical efficacy of RPC-B for adult patients was also analyzed. RESULTS In total, 4,677 untreated regular PC products in plasma were transfused into 914 patients. ATRs developed in 65 patients (7.1%) treated with 92 PC products (2.0%). Multivariate analysis revealed that patients who were elderly, diagnosed with a non-hematological disease, and who received a transfusion of fresh-frozen plasma and red blood cell concentrate products together with PC products had lower frequencies of ATRs. Although 40 patients received 490 RPC-B transfusions, six ATRs (1.2%) were confirmed in five patients (12.5%). The ATR frequency was not significantly lower in the analysis of all patients; however, ATRs in patients with hematological diseases were lower in terms of both the patient and product numbers. Corrected count increments (24 hr) were also within an acceptable range in patients with hematological diseases. CONCLUSION Several patient-specific factors may be associated with the development of ATRs from PC transfusion. Because RPC-B appears to efficiently prevent ATRs, even in adult patients, safe and efficient transfusions may be performed by using RPC-B preferentially depending on the patient's risk factors.
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Affiliation(s)
- Manjiro Yamanaka
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan
| | - Ryu Yanagisawa
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan.,Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan
| | - Shunsuke Kojima
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan.,Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan
| | - Hideyuki Nakazawa
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigetaka Shimodaira
- Department of Regenerative Medicine, Kanazawa Medical University, Uchinada, Japan
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12
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Abstract
Abstract
Transfusion-related acute lung injury is a leading cause of death associated with the use of blood products. Transfusion-related acute lung injury is a diagnosis of exclusion which can be difficult to identify during surgery amid the various physiologic and pathophysiologic changes associated with the perioperative period. As anesthesiologists supervise delivery of a large portion of inpatient prescribed blood products, and since the incidence of transfusion-related acute lung injury in the perioperative patient is higher than in nonsurgical patients, anesthesiologists need to consider transfusion-related acute lung injury in the perioperative setting, identify at-risk patients, recognize early signs of transfusion-related acute lung injury, and have established strategies for its prevention and treatment.
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13
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Moncharmont P. Adverse transfusion reactions in transfused children. Transfus Clin Biol 2019; 26:329-335. [PMID: 31563446 DOI: 10.1016/j.tracli.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/06/2019] [Indexed: 01/28/2023]
Abstract
Transfusion in paediatrics requires specific guidelines, because child physiology and pathology differ significantly as compared to adults. Adverse transfusion reactions in transfused children also vary in type and frequency, but there is a better understanding of these reactions in adults than in children. However, for the most frequent adverse transfusion reactions, the overall prevalence is higher in children than in adults, with the exception of post-transfusion red blood cell alloimmunisation, which is lower, excluding patients with haemoglobinopathies. In several studies, allergic reactions were the most frequently reported adverse transfusion reaction in paediatrics, and the platelet concentrate the most frequently implicated blood product. Early diagnosis of certain adverse transfusion reactions such as haemosiderosis, is essential in order to initiate the best therapy and obtain a good clinical outcome. The prevention of adverse transfusion reactions in children is required, but needs further clinical studies in paediatrics. Lastly, changes in technology, policy and clinical practices will improve transfusion safety in children.
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Affiliation(s)
- P Moncharmont
- Département des vigilances, hémovigilance, établissement français du sang Auvergne Rhône-Alpes, site de Lyon-Décines, 111, rue Élisée-Reclus, CS 20617, 69153 Décines-Charpieu cedex, France.
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Yanagisawa R, Tatsuzawa Y, Ono T, Kobayashi J, Tokutake Y, Hidaka E, Sakashita K, Nakamura T. Analysis of clinical presentations of allergic transfusion reactions and febrile non‐haemolytic transfusion reactions in paediatric patients. Vox Sang 2019; 114:826-834. [DOI: 10.1111/vox.12833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/25/2019] [Accepted: 06/18/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Ryu Yanagisawa
- Division of Blood Transfusion Shinshu University Hospital Matsumoto Japan
- Centre for Advanced Cell Therapy Shinshu University Hospital Matsumoto Japan
- Life Science Research Centre Nagano Children's Hospital Azumino Japan
| | - Yuka Tatsuzawa
- Department of Laboratory Medicine Nagano Children's Hospital Azumino Japan
| | - Takako Ono
- Department of Laboratory Medicine Nagano Children's Hospital Azumino Japan
| | - Jun Kobayashi
- Department of Laboratory Medicine Nagano Children's Hospital Azumino Japan
| | - Yumi Tokutake
- Department of Laboratory Medicine Nagano Children's Hospital Azumino Japan
| | - Eiko Hidaka
- Life Science Research Centre Nagano Children's Hospital Azumino Japan
- Department of Laboratory Medicine Nagano Children's Hospital Azumino Japan
| | - Kazuo Sakashita
- Life Science Research Centre Nagano Children's Hospital Azumino Japan
| | - Tomohiko Nakamura
- Life Science Research Centre Nagano Children's Hospital Azumino Japan
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15
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16
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Standardized Implementation of Evidence-based Guidelines to Decrease Blood Transfusions in Pediatric Intensive Care Units. Pediatr Qual Saf 2019; 4:e165. [PMID: 31579865 PMCID: PMC6594784 DOI: 10.1097/pq9.0000000000000165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/13/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Despite evidence that red blood cell (RBC) transfusions may be associated with more harm than benefit, current transfusion practices vary significantly. This multicenter, quality improvement study aimed to sustainably decrease the rate of RBC transfusions in pediatric intensive care units (PICUs). Methods This 16-month prospective study included 5 PICUs. We implemented a standardized project plan including education, bedside tools, real-time reminders, and email feedback. We collected data from consecutive transfusions during pre-implementation (Phase I), postimplementation (Phase II), and post-stabilization phases (Phase III). Results Of the 2,064 RBC transfusions, we excluded 35% (N = 729) from analysis in patients undergoing extracorporeal membrane oxygenation. Transfusion/1,000 admissions improved throughout the study periods from a baseline 209.6 -199.8 in Phase II and 195.8 in Phase III (P value < 0.05). There were fewer transfusions outside of the hemoglobin threshold guideline, decreasing from 81% of transfusions outside of guidelines in Phase I to 74% in Phases II and III, P < 0.05. Study phase, site, co-management status, service of requesting provider, admit reason, previous transfusion status, and age were associated with transfusion above guideline threshold. Conclusions Multicenter collaboration can successfully deploy a standardized plan that adheres to implementation science principles to sustainably decrease the rate of RBC transfusion outside of guideline thresholds. However, we did not decrease the total number of transfusions in our study. The complexity of multiple specialties co-managing patients is common in the contemporary PICU. Educational initiatives aimed at one specialty may have limited effectiveness in a multifaceted system of care.
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Doctor A, Cholette JM, Remy KE, Argent A, Carson JL, Valentine SL, Bateman ST, Lacroix J. Recommendations on RBC Transfusion in General Critically Ill Children Based on Hemoglobin and/or Physiologic Thresholds From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 2018; 19:S98-S113. [PMID: 30161064 PMCID: PMC6125789 DOI: 10.1097/pcc.0000000000001590] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To present the consensus recommendations and supporting literature for RBC transfusions in general critically ill children from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children. METHODS The panel of 38 experts developed evidence-based and, when evidence was lacking, expert-based recommendations and research priorities regarding RBC transfusions in critically ill children. The subgroup on RBC transfusion in general critically ill children included six experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 30, 2017, using a combination of keywords to define concepts of RBC transfusion and critically ill children. Recommendation consensus was obtained using the Research and Development/UCLA Appropriateness Method. The results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS Three adjudicators reviewed 4,399 abstracts; 71 papers were read, and 17 were retained. Three papers were added manually. The general Transfusion and Anemia Expertise Initiative subgroup developed, and all Transfusion and Anemia Expertise Initiative members voted on two good practice statements, six recommendations, and 11 research questions; in all instances, agreement was reached (> 80%). The good practice statements suggest a framework for RBC transfusion in PICU patients. The good practice statements and recommendations focus on hemoglobin as a threshold and/or target. The research questions focus on hemoglobin and physiologic thresholds for RBC transfusion, alternatives, and risk/benefit ratio of transfusion. CONCLUSIONS Transfusion and Anemia Expertise Initiative developed pediatric-specific good practice statements and recommendations regarding RBC transfusion management in the general PICU population, as well as recommendations to guide future research priorities. Clinical recommendations emphasized relevant hemoglobin thresholds, and research recommendations emphasized a need for further understanding of physiologic thresholds, alternatives to RBC transfusion, and hemoglobin thresholds in populations with limited pediatric literature.
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Affiliation(s)
- Allan Doctor
- Allan Doctor, MD, Professor of Pediatrics and Biochemistry, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis Children’s Hospital, United States
| | - Jill M. Cholette
- Jill M. Cholette, MD, Associate Professor of Pediatrics, Medical Director, Pediatric Cardiac Care Center, University of Rochester, Golisano Children’s Hospital, United States
| | - Kenneth E. Remy
- Kenneth E. Remy, MD, MHSc, Assistant Professor of Pediatrics. Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis Children’s Hospital, United States
| | - Andrew Argent
- Andrew Argent, MD, Professor of Pediatrics, Medical Director, Paediatric Intensive Care, University of Cape Town and Red Cross War Memorial Children’s Hospital, South Africa
| | - Jeffrey L. Carson
- Jeffrey L. Carson, MD, Provost – New Brunswick Distinguished Professor of Medicine, Richard C. Reynolds Chair of General Internal Medicine; Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, United States
| | - Stacey L. Valentine
- Stacey L. Valentine, MD, MPH, Assistant Professor of Pediatrics, University of Massachusetts Medical School, United States
| | - Scot T. Bateman
- Scot T. Bateman, MD, Professor of Pediatrics, Division Chief of Pediatric Critical Care Medicine, University of Massachusetts Medical School, United States
| | - Jacques Lacroix
- Jacques Lacroix, MD, Professor of Pediatrics, Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Canada
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Recommendations on Selection and Processing of RBC Components for Pediatric Patients From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 2018; 19:S163-S169. [PMID: 30161072 PMCID: PMC6126365 DOI: 10.1097/pcc.0000000000001625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To present the recommendations and supporting literature for selection and processing of RBC products in critically ill children developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children METHODS:: The panel of 38 experts developed evidence-based, and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The RBC processing subgroup included five experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS Five recommendations reached agreement (> 80%). Irradiated cellular products are recommended for children at risk of transfusion-associated graft versus host disease due to severe congenital or acquired causes of immune deficiency or when the blood donor is a blood relative. Washed cellular blood components and avoidance of other plasma-containing products are recommended for critically ill children with history of severe allergic reactions or anaphylaxis to blood transfusions, although patient factors appear to be important in the pathogenesis of reactions. For children with history of severe allergic transfusion reactions, evaluation for allergic stigmata prior to transfusion is recommended. In children with severe immunoglobulin A deficiency with evidence of antiimmunoglobulin A antibodies and/or a history of a severe transfusion reaction, immunoglobulin A-deficient blood components obtained either from an immunoglobulin A-deficient donor and/or washed cellular components is recommended. CONCLUSIONS The Transfusion and Anemia Expertise Initiative consensus conference developed recommendations for selection and processing of RBC units for critically ill children. Recommendations in this area are largely based on pediatric and adult case report data.
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De Cloedt L, Emeriaud G, Lefebvre É, Kleiber N, Robitaille N, Jarlot C, Lacroix J, Gauvin F. Transfusion-associated circulatory overload in a pediatric intensive care unit: different incidences with different diagnostic criteria. Transfusion 2018; 58:1037-1044. [PMID: 29388216 DOI: 10.1111/trf.14504] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The incidence of transfusion-associated circulatory overload (TACO) is not well known in children, especially in pediatric intensive care unit (PICU) patients. STUDY DESIGN AND METHODS All consecutive patients admitted over 1 year to the PICU of CHU Sainte-Justine were included after they received their first red blood cell transfusion. TACO was diagnosed using the criteria of the International Society of Blood Transfusion, with two different ways of defining abnormal values: 1) using normal pediatric values published in the Nelson Textbook of Pediatrics and 2) by using the patient as its own control and comparing pre- and posttransfusion values with either 10 or 20% difference threshold. We monitored for TACO up to 24 hours posttransfusion. RESULTS A total of 136 patients were included. Using the "normal pediatric values" definition, we diagnosed 63, 88, and 104 patients with TACO at 6, 12, and 24 hours posttransfusion, respectively. Using the "10% threshold" definition we detected 4, 15, and 27 TACO cases in the same periods, respectively; using the "20% threshold" definition, the number of TACO cases was 2, 6, and 17, respectively. Chest radiograph was the most frequent missing item, especially at 6 and 12 hours posttransfusion. Overall, the incidence of TACO varied from 1.5% to 76% depending on the definition. CONCLUSION A more operational definition of TACO is needed in PICU patients. Using a threshold could be more optimal but more studies are needed to confirm the best threshold.
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Affiliation(s)
- Lise De Cloedt
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Guillaume Emeriaud
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Émilie Lefebvre
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Niina Kleiber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Nancy Robitaille
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Christine Jarlot
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - France Gauvin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
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Second Place Award: Tranexamic acid and intrathecal morphine are synergistic in reducing transfusion requirements in pediatric posterior spinal fusion. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
OBJECTIVES To characterize the determinants of platelet transfusion in a PICU and determine whether there exists an association between platelet transfusion and adverse outcomes. DESIGN Prospective observational single center study, combined with a self-administered survey. SETTING PICU of Sainte-Justine Hospital, a university-affiliated tertiary care institution. PATIENTS All children admitted to the PICU from April 2009 to April 2010. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Among 842 consecutive PICU admissions, 60 patients (7.1%) received at least one platelet transfusion while in PICU. In the univariate analysis, significant determinants for platelet transfusion were admission Pediatric Risk of Mortality Score greater than 10 (odds ratio, 6.80; 95% CI, 2.5-18.3; p < 0.01) and Pediatric Logistic Organ Dysfunction scores greater than 20 (odds ratio, 26.9; 95% CI, 8.88-81.5; p < 0.01), history of malignancy (odds ratio, 5.08; 95% CI, 2.43-10.68; p < 0.01), thrombocytopenia (platelet count, < 50 × 10/L or < 50,000/mm) (odds ratio, 141; 95% CI, 50.4-394.5; p < 0.01), use of heparin (odds ratio, 3.03; 95% CI, 1.40-6.37; p < 0.01), shock (odds ratio, 5.73; 95% CI, 2.85-11.5; p < 0.01), and multiple organ dysfunction syndrome (odds ratio, 10.41; 95% CI, 5.89-10.40; p < 0.01). In the multivariate analysis, platelet count less than 50 × 10/L (odds ratio, 138; 95% CI, 42.6-449; p < 0.01) and age less than 12 months (odds ratio, 3.06; 95% CI, 1.03-9.10; p = 0.02) remained statistically significant determinants. The attending physicians were asked why they gave a platelet transfusion; the most frequent justification was prophylactic platelet transfusion in presence of thrombocytopenia with an average pretransfusion platelet count of 32 ± 27 × 10/L (median, 21), followed by active bleeding with an average pretransfusion platelet count of 76 ± 39 × 10/L (median, 72). Platelet transfusions were associated with the subsequent development of multiple organ dysfunction syndrome (odds ratio, 2.53; 95% CI, 1.18-5.43; p = 0.03) and mortality (odds ratio, 10.1; 95% CI, 4.48-22.7; p < 0.01). CONCLUSIONS Among children, 7.1% received at least one platelet transfusion while in PICU. Thrombocytopenia and active bleeding were significant determinants of platelet transfusion. Platelet transfusions were associated with the development of multiple organ dysfunction syndrome and increased mortality.
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Thromboelastography—does it impact blood component transfusion in pediatric heart surgery? J Surg Res 2016; 200:21-7. [DOI: 10.1016/j.jss.2015.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 11/15/2022]
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Du Pont-Thibodeau G, Robitaille N, Gauvin F, Thibault L, Rivard GÉ, Lacroix J, Tucci M. Incidence of hypotension and acute hypotensive transfusion reactions following platelet concentrate transfusions. Vox Sang 2015; 110:150-8. [PMID: 26389829 DOI: 10.1111/vox.12329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Platelet concentrates (PCs) are associated with transfusion reactions involving hypotension, particularly bradykinin-mediated acute hypotensive transfusion reactions. This study aims to determine the incidence of hypotensive events and more specifically acute hypotensive transfusion reaction associated with PC transfusions. We also sought to ascertain whether these reactions are associated with elevated bradykinin levels. MATERIALS AND METHODS This is a prospective descriptive study of PCs administered at Sainte-Justine Hospital over 28 months. All PCs administered during this period were screened for hypotension through review of all transfusion-associated reaction reports (TARRs) sent to the blood bank. All residual PC bags were returned to the blood bank. TARRs associated with hypotension were reviewed by adjudicators that established the imputability of the PC transfusion to the reaction. Bradykinin levels were sampled in the first 168 PC bags returned to the blood bank. Levels were compared between PCs associated with hypotension and control PCs not associated with hypotension. RESULTS A total of 3672 PC bags were returned to the blood bank; 25 PCs were associated with hypotension. Adjudicators ascertained that five hypotensive events were imputable to PCs of which one was an acute hypotensive transfusion reaction (incidence: 0·03%). Bradykinin level in the latter PC was 10 pg/ml, whereas levels were 226·2 ± 1252 pg/ml in the 143 control PCs. CONCLUSION Our results show a low incidence of hypotension after PC transfusion. We identified only one acute hypotensive transfusion reaction. No correlation between bradykinin level and the occurrence of acute hypotensive reactions could be observed given that only one event was identified.
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Affiliation(s)
- G Du Pont-Thibodeau
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada
| | - N Robitaille
- Division of Hematology-Oncology, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada
| | - F Gauvin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada
| | - L Thibault
- Research and development, Héma-Québec, Québec city, QC, Canada
| | - G-É Rivard
- Division of Hematology-Oncology, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada
| | - J Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada
| | - M Tucci
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada
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Nonpulmonary treatments for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16:S73-85. [PMID: 26035367 DOI: 10.1097/pcc.0000000000000435] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To describe the recommendations from the Pediatric Acute Lung Injury Consensus Conference on nonpulmonary treatments in pediatric acute respiratory distress syndrome. DESIGN Consensus conference of experts in pediatric acute lung injury. METHODS A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. The nonpulmonary subgroup comprised three experts. When published data were lacking, a modified Delphi approach emphasizing strong professional agreement was utilized. RESULTS The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the topics related to pediatric acute respiratory distress syndrome, 30 of which related to nonpulmonary treatment. All 30 recommendations had strong agreement. Patients with pediatric acute respiratory distress syndrome should receive 1) minimal yet effective targeted sedation to facilitate mechanical ventilation; 2) neuromuscular blockade, if sedation alone is inadequate to achieve effective mechanical ventilation; 3) a nutrition plan to facilitate their recovery, maintain their growth, and meet their metabolic needs; 4) goal-directed fluid management to maintain adequate intravascular volume, end-organ perfusion, and optimal delivery of oxygen; and 5) goal-directed RBC transfusion to maintain adequate oxygen delivery. Future clinical trials in pediatric acute respiratory distress syndrome should report sedation, neuromuscular blockade, nutrition, fluid management, and transfusion exposures to allow comparison across studies. CONCLUSIONS The Consensus Conference developed pediatric-specific definitions for pediatric acute respiratory distress syndrome and recommendations regarding treatment and future research priorities. These recommendations for nonpulmonary treatment in pediatric acute respiratory distress syndrome are intended to promote optimization and consistency of care for patients with pediatric acute respiratory distress syndrome and identify areas of uncertainty requiring further investigation.
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Respiratory Dysfunction Associated With RBC Transfusion in Critically Ill Children: A Prospective Cohort Study. Pediatr Crit Care Med 2015; 16:325-34. [PMID: 25647237 DOI: 10.1097/pcc.0000000000000365] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Respiratory complications associated with RBC transfusions may be underestimated in PICUs because current definitions exclude patients with preexisting respiratory dysfunction. This study aims to determine the prevalence and characterize the risk factors and outcomes of new or progressive respiratory dysfunction observed after RBC transfusion in critically ill children. DESIGN Prospective cohort study of all children admitted over a 1-year period. SETTING A multidisciplinary PICU in a tertiary pediatric university hospital. PATIENTS Patients who received a RBC transfusion while in PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two independent adjudicators established the diagnosis of respiratory dysfunction. A respiratory dysfunction associated with transfusion was considered new if it appeared after the first RBC transfusion in PICU. A progressive respiratory dysfunction associated with transfusion was diagnosed if the respiratory dysfunction was present before the transfusion and the PaO2/FIO2 or the SpO2/FIO2 ratio dropped by at least 20% thereafter. Among 842 children admitted into the PICU, 136 received at least one RBC transfusion and were analyzed. Fifty-eight cases of respiratory dysfunction associated with transfusion (43% of transfused patients) were detected, including nine new respiratory dysfunction associated with transfusion (7%) and 49 progressive respiratory dysfunction associated with transfusion (36%). Higher severity of illness, multiple organ dysfunction syndrome prior to transfusion, and volume (mL/kg) of RBC transfusion were independently associated with respiratory dysfunction associated with transfusion. A dose-response relationship was observed between transfusion volume (mL/kg) and the prevalence of respiratory dysfunction associated with transfusion. Patients with respiratory dysfunction associated with transfusion had more progressive multiple organ dysfunction and less ventilation-free and PICU-free days at day 28. CONCLUSIONS Development of respiratory dysfunction associated with transfusion is frequent in PICU and occurs mainly in patients with prior respiratory dysfunction, who would not be identified using current definitions for transfusion-associated complications. A cause-effect relationship cannot be confirmed. However, the high prevalence and the serious adverse outcomes associated with respiratory dysfunction associated with transfusion suggest that this complication should be further studied.
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Hussain S, Moiz B, Ausat FA, Khurshid M. Monitoring and reporting transfusion reactions as a quality indicator – a clinical audit. Transfus Apher Sci 2015; 52:122-7. [DOI: 10.1016/j.transci.2014.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 11/26/2013] [Accepted: 03/11/2014] [Indexed: 10/24/2022]
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Mulder HD, Augustijn QJ, van Woensel JB, Bos AP, Juffermans NP, Wösten-van Asperen RM. Incidence, risk factors, and outcome of transfusion-related acute lung injury in critically ill children: A retrospective study. J Crit Care 2015; 30:55-9. [DOI: 10.1016/j.jcrc.2014.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/07/2014] [Accepted: 10/04/2014] [Indexed: 12/30/2022]
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Oakley FD, Woods M, Arnold S, Young PP. Transfusion reactions in pediatric compared with adult patients: a look at rate, reaction type, and associated products. Transfusion 2014; 55:563-70. [PMID: 25145580 DOI: 10.1111/trf.12827] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/14/2014] [Accepted: 07/14/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The majority of reports on transfusion reactions address adult patients. Less is known about the types, incidence, and other clinical details of transfusion reactions in pediatric populations. Furthermore, to our knowledge, there have been no previous reports directly comparing these aspects between adults and pediatric patient populations to assess if there are differences. STUDY DESIGN AND METHODS Between the period of January 1, 2011, and February 1, 2013, all reported adult and pediatric transfusion reactions at Vanderbilt University Medical Center (VUMC) were evaluated by transfusion medicine clinical service. The information was subsequently shared with the hemovigilance database. Data provided to hemovigilance included age, sex, blood product associated with the reaction, severity of the reaction, and the type of transfusion reactions. These were collated with hospital and blood bank information system-acquired data on overall admission and product transfusion. RESULTS A total of 133,671 transfusions were performed at VUMC during the study period including 20,179 platelet (PLT) transfusions, 31,605 plasma transfusions, 79,933 red blood cell (RBC) transfusions, and 2154 cryoprecipitate transfusions. Over the same period, 108 pediatric and 277 adult transfusion reactions were recorded. This corresponds to an incidence of 6.2 reactions per 1000 transfusions within the pediatric (age < 21) population and an incidence of 2.4 reactions per 1000 transfusions within the adult population. In both adult and pediatric populations, transfusion reactions were most commonly associated with PLT, followed by RBC, and then plasma transfusions. Within the pediatric population, subset analysis identified multiple differences when compared to the adult population, including an increased incidence of allergic transfusion reactions (2.7/1000 vs. 1.1/1000, p < 0.001), febrile nonhemolytic transfusion reactions (1.9/1000 vs. 0.47/1000, p < 0.001), and hypotensive transfusion reactions (0.29/1000 vs. 0.078/1000, p < 0.05). Interestingly, while the reaction incidence was the same between sexes in adults, in pediatric patients, reactions were more common in male patients (7.9/1000 pediatric males vs. 4.3/1000 pediatric females, p < 0.01). CONCLUSION To our knowledge this is the first study to provide detailed comparisons of acute transfusion reactions to all blood products between pediatric and adult populations at a single institution and supported by a single transfusion service and culture. Collectively these data provide insight into pediatric transfusion reactions and demonstrate a general increase in the incidence of transfusion reactions within the pediatric compared to adult population.
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Affiliation(s)
- Fredrick D Oakley
- Department of Pathology, Microbiology and Immunology, Nashville, Tennessee
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Al-Riyami AZ, Al-Hashmi S, Al-Arimi Z, Wadsworth LD, Al-Rawas A, Al-Khabori M, Daar S. Recognition, Investigation and Management of Acute Transfusion Reactions: Consensus guidelines for Oman. Sultan Qaboos Univ Med J 2014; 14:e306-e318. [PMID: 25097764 PMCID: PMC4117654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/10/2014] [Accepted: 04/03/2014] [Indexed: 06/03/2023] Open
Abstract
The recognition and management of transfusion reactions (TRs) are critical to ensure patient safety during and after a blood transfusion. Transfusion reactions are classified into acute transfusion reactions (ATRs) or delayed transfusion reactions, and each category includes different subtypes. Different ATRs share common signs and symptoms which can make categorisation difficult at the beginning of the reaction. Moreover, TRs are often under-recognised and under-reported. To ensure uniform practice and safety, it is necessary to implement a national haemovigilance system and a set of national guidelines establishing policies for blood transfusion and for the detection and management of TRs. In Oman, there are currently no local TR guidelines to guide physicians and hospital blood banks. This paper summarises the available literature and provides consensus guidelines to be used in the recognition, management and reporting of ATRs.
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Affiliation(s)
- Arwa Z. Al-Riyami
- Departments of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sabria Al-Hashmi
- Department of Haematology & Blood Transfusion, Royal Hospital, Muscat, Oman
| | - Zainab Al-Arimi
- Directorate of Blood Services, Ministry of Health, Muscat, Oman
| | - Louis D. Wadsworth
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Shahina Daar
- Department of Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Wolf MJ, Maher KO, Kanter KR, Kogon BE, Guzzetta NA, Mahle WT. Early postoperative bleeding is independently associated with increased surgical mortality in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg 2014; 148:631-6.e1. [DOI: 10.1016/j.jtcvs.2013.10.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 09/12/2013] [Accepted: 10/29/2013] [Indexed: 12/18/2022]
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Waiswa MK, Moses A, Seremba E, Ddungu H, Hume HA. Acute transfusion reactions at a national referral hospital in Uganda: a prospective study. Transfusion 2014; 54:2804-10. [PMID: 24805348 DOI: 10.1111/trf.12684] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/02/2014] [Accepted: 03/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very little has been published about acute transfusion reactions (ATRs) in developing countries. This study was undertaken to determine the incidence, type, imputability, severity, and possible associated factors of ATRs observed in a university-affiliated hospital in Uganda. STUDY DESIGN AND METHODS We prospectively followed the transfusion of blood units issued over a 7-week period from the hospital blood bank during regular working hours to nonbleeding patients. For each transfusion, we recorded the patient's status before, during, at the end of, and 4 hours after transfusion. Three physicians independently reviewed all reports of suspected ATRs and related hospital charts. Using predefined criteria, the presence, type, imputability, and severity of ATRs were adjudicated by consensus of two of three physicians. Factors potentially associated with ATRs were analyzed for statistical significance. RESULTS A total of 507 transfusions were analyzed. Fifty-three acute transfusion events were recorded and 49 of 53 or 9.6% of the 507 transfusions were confirmed to be ATRs by physician consensus: 24 febrile, seven allergic, five hypertensive, three hypotensive, three transfusion-associated circulatory overload, two acute hemolytic, and five others. Imputability of ATRs was definite, probable, or possible in 45 of 49 ATRs (92% of ATRs or 8.9% of transfusions) and judged to be severe in nine of 45. No significant associated factors were identified. CONCLUSIONS Our findings suggest that ATRs may occur more commonly in resource-limited settings than in high-income countries. Although some reactions are unavoidable, improved surveillance of transfusions and implementation of transfusion guidelines could improve the safety of transfusions in these settings.
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Affiliation(s)
- Musa K Waiswa
- Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Lieberman L, Liu Y, Portwine C, Barty RL, Heddle NM. An epidemiologic cohort study reviewing the practice of blood product transfusions among a population of pediatric oncology patients. Transfusion 2014; 54:2736-44. [DOI: 10.1111/trf.12677] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/21/2014] [Accepted: 02/27/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Lani Lieberman
- Department of Clinical Pathology; University Health Network; Toronto Ontario Canada
- Department of Laboratory Medicine & Pathobiology; University of Toronto; Toronto Ontario Canada
| | - Yang Liu
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | - Carol Portwine
- Department of Pediatrics; McMaster University; Hamilton Ontario Canada
| | - Rebecca L. Barty
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | - Nancy M. Heddle
- Department of Medicine; McMaster University; Hamilton Ontario Canada
- Research and Development; Canadian Blood Services; Hamilton Ontario Canada
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Kumar R, Gupta M, Gupta V, Kaur A, Gupta S. Acute Transfusion Reactions (ATRs) in Intensive Care Unit (ICU): A Retrospective Study. J Clin Diagn Res 2014; 8:127-9. [PMID: 24701502 DOI: 10.7860/jcdr/2014/7761.4027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/25/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blood transfusion is a frequent and integral part of critical care. Although life saving, it can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease. AIM To analyze the incidence and spectrum of ATRs occuring in critically ill patients. MATERIALS AND METHODS This was a retrospective review conducted from 1(st) April 2011 till 31(st) March 2013. The ATRs related to the administration of blood components in the patients admitted in various Intensive Care Units (ICUs) were recorded, analyzed and classified on the basis of their clinical features and laboratory tests. RESULTS During the study period 98651 blood components were issued. Out of these 21971 were issued to various ICUs. A total of 225 transfusion reactions were reported from the various critical care departments during this period. The most frequent were Febrile Non Hemolytic Transfusion Reactions (FNHTR) 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs. CONCLUSIONS Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of ATRs. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients.
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Affiliation(s)
- Rajesh Kumar
- Associate Professor, Department of Immunohaematology and Blood Transfusion (IHBT), Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Manvi Gupta
- Senior Resident, Department of IHBT, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Varun Gupta
- Assistant Professor, Department of Surgery, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Amarjit Kaur
- Professor and Head, Department of IHBT, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Sonia Gupta
- Assistant Professor, Department of IHBT, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
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Li N, Williams L, Zhou Z, Wu Y. Incidence of acute transfusion reactions to platelets in hospitalized pediatric patients based on the US hemovigilance reporting system. Transfusion 2014; 54:1666-72. [DOI: 10.1111/trf.12520] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/22/2013] [Accepted: 10/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ning Li
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Lawrence Williams
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Zhiming Zhou
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
| | - YanYun Wu
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven Connecticut
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Moncharmont P, Meyer F. Effets indésirables transfusionnels de nature allergique en pédiatrie, étude sur 3ans. Transfus Clin Biol 2013; 20:455-7. [DOI: 10.1016/j.tracli.2013.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
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Berg A, Courtney R, Krishnamurti L, Triulzi DJ, Yazer MH. Is intensive monitoring during the first transfusion in pediatric patients necessary? Hematology 2013; 19:304-8. [DOI: 10.1179/1607845413y.0000000122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Aaron Berg
- Department of PathologyUniversity of Pittsburgh, Pittsburgh, PA, USA
| | - Rachael Courtney
- Department of Pediatric Hematology/OncologyUniversity of Pittsburgh, Pittsburgh, PA, USA
| | | | - Darrell J. Triulzi
- Department of PathologyUniversity of Pittsburgh, Pittsburgh, PA, USA
- The Institute for Transfusion MedicinePittsburgh, PA, USA
| | - Mark H. Yazer
- Department of PathologyUniversity of Pittsburgh, Pittsburgh, PA, USA
- The Institute for Transfusion MedicinePittsburgh, PA, USA
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Blood transfusion reactions in children: Associated factors. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2012.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Pedrosa AKKV, Pinto FJM, Lins LDB, Deus GM. Blood transfusion reactions in children: associated factors. J Pediatr (Rio J) 2013; 89:400-6. [PMID: 23791024 DOI: 10.1016/j.jped.2012.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/19/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyze the profile of blood transfusion reactions in children and to identify the involved factors. METHODS This was a cross-sectional study in a tertiary pediatric teaching hospital from the public healthcare system, involving all children admitted from January to July of 2011 (5,437), of which 1,226 received blood transfusions, constituting the sample. A documental study was performed by analyzing files from the hemovigilance service and notification forms of transfusion reactions. The variables investigated were: number and type of blood components transfused, transfusion site, reaction site, age, gender, type of blood components involved, type of incident, and previous history of multiple transfusions. A descriptive and inferential analysis was performed, using statistical tests to establish the association between the variables. RESULTS There were 57 transfusion incidents involving 47 children and 72 different blood products, thus constituting a prevalence of reactions of 3.8%. At the inferential analysis, the chi-squared test showed that the following variables were significantly associated (p<0.05) with the type of reaction: age range and type of blood component. Similarly, the patient's underlying disease was associated with previous history of transfusion incident and type of blood component. CONCLUSIONS The prevalence of transfusion reactions in children is high, and the intervening factors are: type of blood component, age, patient comorbidity, and multiple transfusions; type of blood component and age are also associated with type of reaction.
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Lieberman L, Petraszko T, Yi QL, Hannach B, Skeate R. Transfusion-related lung injury in children: a case series and review of the literature. Transfusion 2013; 54:57-64. [PMID: 23763359 DOI: 10.1111/trf.12249] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. The majority of the literature involves adult patients. The main objective of this study was to characterize the demographic features, clinical presentation, patient outcomes, and antibody profiles of TRALI patients reported to the Canadian Blood Service (CBS) and to assess similarities and differences between adult and pediatric TRALI cases. STUDY DESIGN AND METHODS A retrospective review of cases of TRALI submitted to the CBS from 2001 to 2011 was performed. Information collected included recipient demographics, event details, blood component transfused, morbidity and mortality data, and donor antibody results. RESULTS A total of 284 cases of definite, possible, or probable TRALI were reported. Six percent (n = 17) occurred in children. There were no significant differences between pediatric or adult patients with TRALI. Most of the children who presented with TRALI were either teenagers or less than 1 year of age. The incident rate of reported TRALI cases in Canada per 100,000 red blood cell transfusions was estimated at 5.58 for children and 3.75 for adults. CONCLUSIONS This study is the largest case series of reported TRALI cases in children. Crude modeling suggests that the incidence of TRALI in children is similar to that of adults. Although the numbers are small, there do not appear to be differences in presentation or outcome between adults and children with TRALI. TRALI is associated with significant morbidity and mortality and pediatricians need to consider this diagnosis in children who experience respiratory distress after transfusions.
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Affiliation(s)
- Lani Lieberman
- Department of Laboratory Hematology (Blood Transfusion Medicine Laboratory), University Health Network / Toronto General Hospital, Toronto, Ontario, Canada; Canadian Blood Services, Ottawa, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada
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Rashid N, Al-Sufayan F, Seshia MMK, Baier RJ. Post transfusion lung injury in the neonatal population. J Perinatol 2013; 33:292-6. [PMID: 22955289 DOI: 10.1038/jp.2012.114] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study was to examine the changes in level of respiratory support following transfusion in neonates who require intermediate or intensive care. STUDY DESIGN Data on respiratory support were collected retrospectively from the medical record before, during and after transfusion. Neonatal post transfusion lung injury (NPTLI) was defined as an increase in the highest mean airway pressure (MAP) of ≥2 cm H(2)O or FiO(2) >0.15 in the 6-h after transfusion that persisted from 6 to 18 h post transfusion. RESULT A total of 373 (330 packed red blood cell) transfusions were given to 108 infants. NPTLI occurred following 31 (8.3%) transfusions in 23 patients. During the first 6 h after transfusion, FiO2 or MAP was increased in 47 transfusions (12.6%) and the changes persisted in 31 transfusions (7.8%). Infants who developed NPTLI were less mature (27.1±0.7 vs 31.0±0.5 weeks; P=0.005) and of lower birth weight (1001±110 vs1692±104 g; P=0.001). Infants who developed NPTLI were more likely to develop necrotizing enterocolitis (6/24 vs 4/85; P=0.002) and die within 24 h of transfusion (5/22 vs 3/85; P=0.003). CONCLUSION In neonates receiving intensive or intermediate care, blood transfusion was associated with need for increased respiratory support in a significant number of cases. Development of NPTLI was associated with poorer outcomes.
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Affiliation(s)
- N Rashid
- Department of Paediatrics and Child Health, University of Manitoba, CS 408 Health Sciences Centre, Winnipeg, MB, Canada
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Anemia among Pediatric Critical Care Survivors: Prevalence and Resolution. Crit Care Res Pract 2013; 2013:684361. [PMID: 23509619 PMCID: PMC3600205 DOI: 10.1155/2013/684361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/20/2013] [Indexed: 11/17/2022] Open
Abstract
To determine the incidence of anemia among pediatric critical care survivors and to determine whether it resolves within 6 months of discharge. Design. A prospective observational study. Patients with anemia upon discharge from the pediatric critical care unit (PCCU) underwent in hospital and post hospital discharge followup (4-6 months) for hemoglobin (Hb) levels. Setting. A medical-surgical PCCU in a tertiary care center. Patients. Patients aged 28 days to 18 years who were treated in the PCCU for over 24 hours. Measurements and Main Results. 94 (24%) out of 392 eligible patients were anemic at time of discharge. Patients with anemia were older, median 8.0 yrs [(IQR 1.0-14.4) versus 3.2 yrs (IQR 0.65-9.9) (P < 0.001)], and had higher PeLOD [median 11 (IQR 10-12) versus 1.5 (1-4) (P < 0.001)], and PRISM [median 5 (IQR 2-11) versus 3 (IQR 0-6) (P < 0.001)] scores. The Hb level normalized in 32% of patients before discharge from hospital. Of the 28 patients who completed followup, all had normalization of their Hb in the absence of medical intervention. Conclusions. Anemia is not common among patients discharged from the PCCU and recovers spontaneously within 4-6 months.
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Yanagisawa R, Shimodaira S, Kojima S, Nakasone N, Ishikawa S, Momose K, Honda T, Yoshikawa K, Saito S, Tanaka M, Nakazawa Y, Sakashita K, Shiohara M, Akino M, Hirayama J, Azuma H, Koike K. Replaced platelet concentrates containing a new additive solution, M-sol: safety and efficacy for pediatric patients. Transfusion 2012; 53:2053-60. [DOI: 10.1111/trf.12025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 10/30/2012] [Accepted: 10/30/2012] [Indexed: 11/29/2022]
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de Sousa Neto AL, Barbosa MH. Analysis of immediate transfusion incidents reported in a regional blood bank. Rev Bras Hematol Hemoter 2012; 33:337-41. [PMID: 23049336 PMCID: PMC3415786 DOI: 10.5581/1516-8484.20110095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 02/23/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Blood transfusion is imperative when treating certain patients; however, it is not risk free. In addition to the possible transmission of contagious infectious diseases, incidents can occur immediately after transfusion and at a later time. AIMS This study aimed to examine the immediate transfusion incidents reported in a regional blood bank in the state of Minas Gerais between December 2006 and December 2009. A retrospective quantitative epidemiological study was conducted. Data were obtained from 202 transfusion incident reports of 42 health institutions served by the blood bank. Data processing and analysis were carried out using the Statistical Package for the Social Sciences (SPSS) software. RESULTS The rate of immediate transfusion incidents reported in the period was 0.24%; febrile non-hemolytic reactions were the most common type of incident (56.4%). The most frequent clinical manifestations listed in transfusion incident reports were chills (26.9%) and fever (21.6%). There was a statistically significant association (p-value < 0.05) between the infusion of platelet concentrates and febrile non-hemolytic reactions and between fresh frozen plasma and febrile non-hemolytic reaction. The majority (73.3%) of transfused patients who suffered immediate transfusion incidents had already been transfused and 36.5% of the cases had previous transfusion incident reports. CONCLUSIONS Data from the present study corroborate the implementation of new professional training programs aimed at blood transfusion surveillance. These measures should emphasize prevention, identification and reporting of immediate transfusion incidents aiming to increase blood transfusion quality and safety.
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Tinegate H, Birchall J, Gray A, Haggas R, Massey E, Norfolk D, Pinchon D, Sewell C, Wells A, Allard S. Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force. Br J Haematol 2012; 159:143-53. [PMID: 22928769 DOI: 10.1111/bjh.12017] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although acute non-haemolytic febrile or allergic reactions (ATRs) are a common complication of transfusion and often result in little or no morbidity, prompt recognition and management are essential. The serious hazards of transfusion haemovigilance organisation (SHOT) receives 30-40 reports of anaphylactic reactions each year. Other serious complications of transfusion, such as acute haemolysis, bacterial contamination, transfusion-related acute lung injury (TRALI) or transfusion-associated circulatory overload (TACO) may present with similar clinical features to ATR. This guideline describes the approach to a patient developing adverse symptoms and signs related to transfusion, including initial recognition, establishing a likely cause, treatment, investigations, planning future transfusion and reporting within the hospital and to haemovigilance organisations. Key recommendations are that adrenaline should be used as first line treatment of anaphylaxis, and that transfusions should only be carried out where patients can be directly observed and where staff are trained in manging complications of transfusion, particularly anaphylaxis. Management of ATRs is not dependent on classification but should be guided by symptoms and signs. Patients who have experienced an anaphylactic reaction should be discussed with an allergist or immunologist, in keeping with UK resuscitation council guidelines.
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Affiliation(s)
- Hazel Tinegate
- NHS Blood and Transplant, Holland Drive, Newcastle upon Tyne, UK.
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Lacroix J, Demaret P, Tucci M. Red blood cell transfusion: decision making in pediatric intensive care units. Semin Perinatol 2012; 36:225-31. [PMID: 22818542 DOI: 10.1053/j.semperi.2012.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The results of the Transfusion Requirements in Pediatric Intensive Care Unit study suggest that a red blood cell transfusion is not required in stable or stabilized pediatric intensive care unit children as long as their hemoglobin level is >7 g/dL. Subgroup analyses suggest that this recommendation is also adequate for stable critically ill children with a high severity of illness, respiratory dysfunction, acute lung injury, sepsis, neurological dysfunction, severe head trauma, or severe trauma, and during the postoperative period, for noncyanotic patients older than 28 days. A small randomized clinical trial suggests that a hemoglobin level of 9 g/dL is safe in the postoperative care of children with single-ventricle physiology undergoing cavopulmonary connection. Although there is consensus that blood is clearly indicated for the treatment of hemorrhagic shock, the clinical determinants that should prompt pediatric intensivists to prescribe a red blood cell transfusion to unstable PICU children are not well characterized.
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Affiliation(s)
- Jacques Lacroix
- Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Quebec, Canada.
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Gauvin F, Robillard P, Hume H, Grenier D, Whyte RK, Webert KE, Fergusson D, Lau W, Froese N, Delage G. Transfusion-related acute lung injury in the Canadian paediatric population. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.5.235] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - France Gauvin
- Department of Paediatrics, CHU Sainte-Justine, Université de Montréal
| | - Pierre Robillard
- Institut national de santé publique du Québec, Hemovigilance Research Unit and Department of Epidemiology, McGill University, Montréal, Québec
| | - Heather Hume
- Department of Paediatrics, CHU Sainte-Justine, Université de Montréal
- Canadian Blood Services
| | - Danielle Grenier
- Department of Paediatrics, Children’s Hospital of Eastern Ontario, Ottawa University, Ottawa, Ontario
| | - Robin K Whyte
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | - Kathryn E Webert
- Departments of Medicine/Molecular Medicine and Pathology, McMaster University, Hamilton
| | - Dean Fergusson
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa
| | - Wendy Lau
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children; University of Toronto, Toronto, Ontario
| | - Norbert Froese
- Departments of Anaesthesia and Paediatrics, University of British Columbia, Vancouver, British Columbia
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Agrawal AK, Hsu E, Quirolo K, Neumayr LD, Flori HR. Red blood cell transfusion in pediatric patients with severe chronic anemia: how slow is necessary? Pediatr Blood Cancer 2012; 58:466-8. [PMID: 21793178 DOI: 10.1002/pbc.23238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/19/2011] [Indexed: 11/11/2022]
Abstract
Historic practice recommends slow transfusion for children with chronic anemia and hemoglobin less than 5.0 g/dl due to the theoretical risk of transfusion-associated circulatory overload (TACO). In our pediatric intensive care unit (PICU), we have been utilizing a more liberal transfusion practice in patients without underlying cardiopulmonary disease, and a faster transfusion rate appears safe in this population. Rate of transfusion must be based on multiple factors including convenience, timeliness of procedures and transport to an appropriate care facility, risk of alloimmunization and wastage of blood, stress for the family, and need for PICU monitoring.
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Affiliation(s)
- Anurag K Agrawal
- Children's Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA.
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Sousa Neto ALD, Barbosa MH. Incidentes transfusionais imediatos: revisão integrativa da literatura. ACTA PAUL ENFERM 2012. [DOI: 10.1590/s0103-21002012000100025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo de revisão integrativa da literatura teve como objetivo analisar as pesquisas que abordam a ocorrência de incidentes transfusionais imediatos e ações de hemovigilância implantadas. Os dados foram obtidos por meio de busca nas bases de dados - LILACS, MEDLINE e PUBMED - abrangendo o período de 1980 a 2009, nos idiomas português, inglês e espanhol. Foram identificados 1.382 artigos, dos quais 29 atenderam aos critérios de inclusão estabelecidos. Destes artigos, 20 (69,0%) eram estudos retrospectivos transversais, 8 (27,5%) prospectivos e um (3,5%) caso-controle. Em relação à abordagem, os estudos foram classificados em dois focos temáticos: tipos de incidentes transfusionais imediatos e ações de hemovigilância implantadas associadas aos tipos de incidentes transfusionais imediatos. A análise dos trabalhos destacou a maior ocorrência de reação febril não hemolítica e alérgica, avanço em ações de hemovigilância e maior preocupação com a qualidade da assistência hemoterápica.
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