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Transfusion practices in a large cohort of hospitalized children
Marianne E Nellis1, Ruchika Goel2, Jeanne E Hendrickson3
1Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA.
Insights
Blood component transfusions are common in hospitalized children, with red blood cell transfusions being the most frequent. These findings emphasize the need for pediatric transfusion guidelines and patient blood management programs.
Area of Science:
- Pediatric Hematology
- Transfusion Medicine
- Hospital Medicine
Background:
- Limited understanding of blood component transfusion practices across diverse pediatric hospital settings.
- Previous research focused on specific pediatric subsets, like critically ill children.
- Need for comprehensive data on transfusion utilization in general pediatric inpatient populations.
Purpose of the Study:
- To describe the utilization of red blood cell, platelet, plasma, and cryoprecipitate transfusions.
- To analyze transfusion practices across various hospital settings and diagnostic categories in children.
- To provide a broad overview of blood component use in pediatric inpatient care.
Main Methods:
- Analysis of public datasets from 11 US academic and community hospitals (REDS-III).
- Inclusion of all non-birth inpatient encounters for children aged 0-18 years from 2013 to 2016.
- Examination of transfusion data across different departments and diagnoses.
Main Results:
- Nine percent of 61,770 inpatient encounters involved at least one blood component transfusion.
- Red blood cell (RBC) transfusions were most common (7.5%), followed by platelets (3.9%), plasma (2.5%), and cryoprecipitate (0.9%).
- Children undergoing cardiopulmonary bypass had the highest transfusion likelihood; significant age-related differences in RBC irradiation and storage duration were noted.
Conclusions:
- Blood component transfusion is a common practice in hospitalized children.
- High transfusion frequency, particularly in specific groups like those undergoing cardiopulmonary bypass, indicates opportunities for guideline development.
- The study highlights the importance of institutional transfusion guidelines and patient blood management initiatives in pediatrics.
Background:
While previous studies have described the use of blood components in subsets of children, such as the critically ill, little is known about transfusion practices in hospitalized children across all departments and diagnostic categories. We sought to describe the utilization of red blood cell, platelet, plasma, and cryoprecipitate transfusions across hospital settings and diagnostic categories in a large cohort of hospitalized children.
Study Design And Methods:
The public datasets from 11 US academic and community hospitals that participated in the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) were accessed. All nonbirth inpatient encounters of children 0-18 years of age from 2013 to 2016 were included.
Results:
61,770 inpatient encounters from 41,943 unique patients were analyzed. Nine percent of encounters involved the transfusion of at least one blood component. RBC transfusions were most common (7.5%), followed by platelets (3.9%), plasma (2.5%), and cryoprecipitate (0.9%). Children undergoing cardiopulmonary bypass were most likely to be transfused. For the entire cohort, the median (interquartile range) pretransfusion laboratory values were as follows: hemoglobin, 7.9 g/dl (7.1-10.4 g/dl); platelet count, 27 × 109 cells/L (14-54 × 109 cells/L); and international normalized ratio was 1.6 (1.4-2.0). Recipient age differences were observed in the frequency of RBC irradiation (95% in infants, 67% in children, p < .001) and storage duration of RBC transfusions (median storage duration of 12 [8-17] days in infants and 20 [12-29] days in children, p < .001).
Conclusion:
Based on a cohort of patients from 2013 to 2016, the transfusion of blood components is relatively common in the care of hospitalized children. The frequency of transfusion across all pediatric hospital settings, especially in children undergoing cardiopulmonary bypass, highlights the opportunities for the development of institutional transfusion guidelines and patient blood management initiatives.
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