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Transfusion Strategies for Hemostatic Blood Products in Critically Ill Children: A Narrative Review and Update on
Stacey L Valentine1, Jill M Cholette2, Susan M Goobie3
1From the Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
Insights
Critically ill children often need blood products like plasma and platelets. This review guides clinicians on when to transfuse these hemostatic agents, balancing benefits against risks.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Transfusion medicine
Background:
- Critically ill children frequently require coagulant products for hemorrhage or coagulopathy.
- Pediatric physiology and critical illness complexity necessitate careful consideration of transfusion risks.
- Current transfusion practices for pediatric patients are inconsistent, highlighting a need for evidence-based guidelines.
Purpose of the Study:
- To provide recent recommendations and expert consensus on hemostatic blood product transfusion in critically ill children.
- To guide clinical decision-making regarding the transfusion of plasma, platelets, cryoprecipitate, and recombinant products.
- To address the variability in transfusion practices within and across institutions.
Main Methods:
- Review of recent recommendations and expert consensus statements.
- Synthesis of current evidence regarding hemostatic blood product transfusion in pediatric critical care.
- Focus on balancing transfusion benefits against known risks in this population.
Main Results:
- Recent guidelines offer direction for transfusion decisions in critically ill children.
- Expert consensus addresses the use of plasma, platelets, cryoprecipitate, and recombinant products.
- Emphasis on individualized patient assessment considering physiology and illness severity.
Conclusions:
- Evidence-based guidance is crucial for optimizing hemostatic blood product transfusion in critically ill children.
- Clinicians should weigh potential benefits against transfusion risks based on current recommendations.
- Standardized, evidence-informed transfusion practices can improve outcomes for pediatric patients.
Abstract:
Critically ill children commonly receive coagulant products (plasma and/or platelet transfusions) to prevent or treat hemorrhage or correct coagulopathy. Unique aspects of pediatric developmental physiology, and the complex pathophysiology of critical illness must be considered and balanced against known transfusion risks. Transfusion practices vary greatly within and across institutions, and high-quality evidence is needed to support transfusion decision-making. We present recent recommendations and expert consensus statements to direct clinicians in the decision to transfuse or not to transfuse hemostatic blood products, including plasma, platelets, cryoprecipitate, and recombinant products to critically ill children.
