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Red blood cell transfusions in children awaiting heart transplantation
William T Mahle1, Alexandria M Berg, Kirk R Kanter
1Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322-1062, USA. wmahle@emory.edu
Insights
Red blood cell (RBC) transfusions are common in children awaiting heart transplants. These transfusions pose a very low risk of allosensitization, a key concern for transplant candidates.
Area of Science:
- Pediatric Cardiology
- Transplantation Immunology
- Hematology
Background:
- Children awaiting heart transplantation face a critical balance between the benefits of red blood cell (RBC) transfusion and the risk of allosensitization.
- Understanding transfusion practices and their immunologic impact is crucial for optimizing care in this vulnerable population.
Purpose of the Study:
- To describe the utilization of RBC transfusions and erythropoietin in pediatric heart failure patients listed for transplantation.
- To assess the impact of these interventions on the development of allosensitization.
Main Methods:
- Retrospective analysis of hospitalized pediatric patients listed for heart transplantation between January 2003 and December 2010.
- Exclusion of patients on mechanical support or with pre-existing high sensitization.
- Evaluation of RBC transfusion frequency and erythropoietin administration, along with changes in panel reactive antibody (PRA) levels.
Main Results:
- A majority of eligible patients (75%) received at least one RBC transfusion during the waitlist period, with a median of 3 transfusions.
- Erythropoietin was administered to 55% of subjects but was not significantly associated with a reduced need for transfusion (p = 0.61).
- None of the transfused patients developed significant elevation in serum PRA by the time of transplant, indicating a low risk of allosensitization.
Conclusions:
- RBC transfusion is a frequent intervention for hospitalized children awaiting heart transplantation.
- Leukoreduced RBC transfusions appear to carry an extremely low risk of causing allosensitization in this cohort.
- The routine use of erythropoietin to decrease transfusion requirements requires further investigation to determine its benefit.
Abstract:
In children awaiting heart transplantation, the benefits of RBC transfusion must be weighed against the potential risks of allosensitization. We sought to describe the use of RBC transfusion and erythropoietin in children with heart failure, as well as assess the impact of these measures on allosensitization. Hospitalized patients listed for heart transplantation between 1/03 and 12/10 were included in the analysis. We excluded patients supported by mechanical support or those highly sensitized prior to listing. Sixty-seven subjects (median age of 6.2 yr) met inclusion criteria. The mean waitlist time was 19.5 days. The majority of subjects, 50 (75%), received at least one RBC transfusion while listed. For those who were transfused, the median number of RBC transfusion events was 3, range: 1-8. Erythropoietin was given to 37 (55%) of subjects. Erythropoietin administration was not associated with subsequent need for transfusion (p = 0.61). Of the 50 subjects who received RBC transfusion, none developed significant elevation of serum PRA by the time of transplant. RBC transfusion may be commonly undertaken in hospitalized children awaiting transplantation. The likelihood of allosensitization following leukoreduced RBC transfusion is extremely low. The benefits of routine erythropoietin administration to reduce the need for transfusion remain to be determined.
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