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Rational use of blood products
1Institute of Immunology, Rikshospitalet, The National Hospital University of Oslo, NO-0027 Oslo, Norway. bjarte.solheim@rikshospitalet.no
Insights
Paediatric blood product transfusions are crucial for children with cancer, blood disorders, or after major trauma. Careful consideration of transfusion triggers, volumes, and rates is vital due to potentially serious, long-lasting complications in children.
Area of Science:
- Pediatric Hematology
- Transfusion Medicine
- Oncology Supportive Care
Background:
- Blood product transfusions are essential supportive care for pediatric patients with oncological or hematological conditions, major surgery, or trauma.
- Paediatric transfusions present unique challenges due to the potential for more durable and serious long-term complications compared to adults.
- While indications are similar to adults, transfusion thresholds, volumes, and rates must be age-adjusted in children.
Purpose of the Study:
- To review current blood products used in pediatric transfusions.
- To provide guidance on transfusion "triggers" for major pediatric surgery and hematological/oncological practice.
- To explore future developments and novel possibilities in pediatric transfusion therapy.
Main Methods:
- Literature review and synthesis of current practices in pediatric transfusion.
- Discussion of age-specific considerations for transfusion thresholds, volumes, and infusion rates.
- Consideration of evidence supporting transfusion triggers in specific pediatric scenarios.
Main Results:
- Current blood products and their indications in pediatric care are discussed.
- Specific transfusion triggers are suggested for major pediatric surgery and hematological/oncological settings.
- The unique challenges and long-term implications of transfusion complications in children are highlighted.
Conclusions:
- Paediatric transfusions require careful management due to heightened risks and long-term consequences.
- Age-appropriate adjustments in transfusion parameters are critical for optimizing outcomes.
- Ongoing research and future developments hold promise for improving pediatric transfusion safety and efficacy.
Abstract:
Blood product transfusions can be life saving and must be considered in the supportive care of children of any age with underlying oncological or haematological problems, as well as after major surgery or after serious trauma. Paediatric transfusions are particularly challenging because life-long effects of transfusion complications are more durable and serious in children than in adults, in whom the median age at transfusion is >70 years (Tynell E, Norda R, Shanwell A, Björkman A. Long-term survival in transfusion recipients in Sweden, 1993. Transfusion 2001, 41, 251-255). While the general indications for transfusions in paediatric patients are similar to adults, the threshold, volumes and infusion rates for transfusions vary with age. In this Update, we discuss current blood products, then suggest transfusion "triggers" in major surgery and haematological and oncologic practice. Finally, future developments and new possibilities are considered.