Transfusion management strategies: a survey of practicing pediatric hematology/oncology specialists

Little is known about the criteria used by pediatric oncologists for the transfusion of red blood cells and platelets to pediatric oncology patients.

Data regarding red blood cell and platelet transfusion practices were collected with an internet-based survey of physician members of the American Society for Pediatric Hematology/Oncology (ASPH/O). Respondents were asked to define platelet and red blood cell transfusion thresholds in a variety of clinical scenarios, and to describe criteria for dealing with cytomegalovirus (CMV) transmission from blood products, platelet dosing strategies, and prevention of RhD alloimmunization.

The overall response rate was 31.4% (264 of 841). Of the respondents, 76% indicated that their institution had defined criteria for acceptable transfusion practice; of these respondents, 114 (57%) indicated that there were special guidelines for pediatric oncology patients. Examination of the distribution of threshold platelet counts and hemoglobin levels that would prompt transfusion indicated a wide range of transfusion practice in commonly encountered clinical scenarios. Similar variability in practice was evident in platelet dosing strategies, CMV prevention strategies, and in the use of anti-D in RhD-negative patients who received RhD-positive platelets.

This current survey demonstrates that transfusion practices vary widely among pediatric hematology/oncology specialists and that prospective clinical trials may be necessary to determine optimal criteria for blood product support in pediatric oncology patients.