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Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for
Galila Mokhtar1, Amira Adly1, Ashraf Abdel Baky2,3,4
1Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt.
Insights
This study adapted existing guidelines for pediatric blood transfusions, creating a national clinical practice guideline (CPG) for safe transfusion in children. The CPG provides evidence-based recommendations for healthcare professionals across Egypt.
Area of Science:
- Pediatric Hematology
- Transfusion Medicine
- Clinical Practice Guidelines
Background:
- Pediatric transfusion practice lacks high-quality research compared to adult medicine.
- Existing guidelines require adaptation for diverse pediatric age groups and national contexts.
Purpose of the Study:
- To adapt existing high-quality transfusion guidelines for national use in Egypt.
- To provide evidence-based recommendations for pediatric transfusion practices for healthcare professionals.
Main Methods:
- Utilized the Adapted ADAPTE methodology for guideline adaptation.
- Included a systematic search, quality appraisal, and contextual adaptation of recommendations.
- Convened a panel of 17 Egyptian experts for guideline development.
Main Results:
- Developed an adapted clinical practice guideline (CPG) covering indications, dosing, and administration of blood components.
- Included recommendations for special pediatric situations, massive blood loss, and surgical transfusions.
- Created implementation tools such as algorithms and flow charts to support clinical decision-making.
Conclusions:
- The adapted CPG provides a valuable tool for safe transfusion practices in pediatric patients in Egypt.
- Enhances evidence-based care for neonates, children, and young adults requiring blood transfusions.
- Facilitates consistent and safe transfusion management across various pediatric age groups and clinical scenarios.
Abstract:
Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.
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