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Updated: May 17, 2026

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload

Published on: March 14, 2017

A pediatric massive transfusion protocol.

Sara J Chidester¹, Nick Williams, Wei Wang

¹Bellevue Hospital Center, Department of Emergency Medicine, New York University, New York, New York, USA.

The Journal of Trauma and Acute Care Surgery

|October 16, 2012

Summary

Pediatric massive transfusion protocols (MTPs) reduce thromboembolic events. Coagulopathy often triggers MTP initiation in critically ill children, warranting further research into MTP benefits and objective initiation factors.

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Area of Science:

Pediatric critical care medicine
Trauma surgery
Hematology

Background:

Pediatric massive blood transfusions are common, but data on massive transfusion protocols (MTPs) are limited.
This study introduces a pediatric MTP and evaluates its impact on patient outcomes.
Factors influencing MTP activation were also investigated.

Purpose of the Study:

To assess the impact of a pediatric massive transfusion protocol (MTP) on morbidity and mortality.
To identify factors associated with the initiation of a pediatric MTP.
To compare outcomes between patients managed under an MTP and those receiving transfusions at physician discretion.

Main Methods:

Prospective cohort study of pediatric patients requiring un-cross-matched blood.
Data collected from January 1, 2009, to January 1, 2011.
Comparison of outcomes between MTP and non-MTP groups.

Main Results:

No significant difference in mortality between MTP and non-MTP groups.
MTP group had a higher Injury Severity Score (42 vs. 25, p ≤ 0.01).
Thromboembolic complications were less frequent in the MTP group (p ≤ 0.04).
Coagulopathy (PTT > 36) was associated with MTP initiation.

Conclusions:

Massive transfusion protocols (MTPs) may minimize coagulopathy in pediatric hemorrhage.
MTP use was linked to fewer thromboembolic events.
Coagulopathy is a key indicator for MTP activation, suggesting further research is needed.