Massive Bleeding in Children With Cancer or Hematopoietic Cell Transplant: International, Multicenter Retrospective...

Area of Science:

• Pediatric Hematology/Oncology
• Critical Care Medicine
• Transfusion Medicine

Background:

• Massive bleeding is a critical complication in pediatric patients with cancer and/or undergoing hematopoietic cell transplant (HCT).
• Understanding the epidemiology and management of these events is crucial for improving patient outcomes.

Purpose of the Study:

• To characterize the epidemiology of massive bleeding events in pediatric oncology and HCT patients.
• To analyze the management strategies and outcomes associated with massive bleeding in this vulnerable population.

Main Methods:

• A multicenter, retrospective cohort study was conducted across 19 pediatric hospitals in Europe and the United States.
• Data were collected for 135 children (ages 0-21) with malignancy and/or HCT experiencing massive bleeding between January 2017 and December 2021.
• Demographics, oncologic history, laboratory values, interventions, and pediatric intensive care unit (PICU) outcomes were analyzed.

Main Results:

• 152 bleeding episodes were analyzed; 19% of patients died due to hemorrhage.
• Common bleeding sites included pulmonary and oral/nasal regions; patients often had solid tumors or prior HCT.
• While most patients received balanced resuscitation with red blood cells, plasma, and platelets, specific interventions like pulmonary bleeding, oral/nasal bleeding, and receipt of prothrombin complex concentrate were associated with increased mortality.

Conclusions:

• Pediatric patients with malignancy and/or HCT face a high mortality rate from hemorrhage, even with hospitalization.
• Current resuscitation practices appear balanced but are insufficient to overcome the high risk of death.
• Further clinical trials are essential to establish optimal hemostatic resuscitation strategies for this population.