A single center experience of transfusion related adverse reaction in pediatric patients with malignant solid and...

This study aimed to analyze the clinical characteristics and rate of transfusion related adverse reactions (TRARs) in pediatric patients with malignant solid and hematological tumors.

A retrospective analysis was conducted on 34,195 blood transfusions (RBC: 41.0%; PLT: 40.7%; FFP: 16.0%; cryoprecipitate: 2.3%) among 9,129 pediatric patients. TRARs were classified and severity graded according to the Chinese Haemovigilance Network criteria. Statistical comparisons were made between serious (n = 37) and non-serious (n = 194) TRAR cases.

The overall TRAR rate was 680/100,000 (231/34,195), with PLT-associated TRARs being most frequent (1,250/100,000, 174/13,915). Allergic transfusion reactions (ATRs) dominated (95.7%, 221/231), followed by febrile non-hemolytic reactions (FNHTRs, 3.5%, 8/231). Serious TRARs (16.0%, 37/231) primarily involved ATRs (91.9%, 34/37), presenting with respiratory/gastrointestinal symptoms (41.2%) or anaphylactic shock (14.7%). After adjustment for multiple comparisons using the Bonferroni correction, prophylactic premedication was significantly associated with the occurrence of serious TRARs (p < 0.001).

Pediatric patients with malignant solid and hematological tumors exhibit a high TRAR incidence, particularly with PLT transfusions. ATRs constitute the majority, underscoring the need for vigilant monitoring and evidence-based prophylaxis. The inefficacy of routine premedication raises important questions about tailored transfusion strategies. Further research is warranted to optimize platelet product selection and TRAR management protocols in this vulnerable population.