Blood transfusion risks and alternative strategies in pediatric patients

Lavoie, Judith

doi:10.1111/j.1460-9592.2010.03470.x

Cited by 180 publications

(155 citation statements)

References 64 publications

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“…Therefore, allotransfusion in pediatric donors should be avoided when possible. Preoperative autologous donation (PAD) programs have been instituted widely to reduce the risks of allotransfusions, 15 but there have been few reports of its use in…”

Section: Discussionmentioning

confidence: 99%

Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion

Yabe

Morimoto

Shimizu

et al. 2014

Bone Marrow Transplant

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We retrospectively studied 108 marrow harvests from 105 pediatric sibling donors. The median age of donors was 8 years (range: 1-15) and the median body weight was 27 kg (range: 10-100). The volumes of aspirated marrow were 5.0-23.8 mL/kg donor body weight, and harvested bone marrow volume exceeded 15 mL/kg in 42% of the donors. A total of 100 autologous blood donations were performed, and eight donors had red cells salvaged from their harvests reinfused. The median Hb levels before and after harvests were 12.3 g/dL (range: 10.0-14.7) and 11.0 g/dL (range: 8.9-13.8), respectively. None of the donors received allogeneic blood transfusions or hematopoietic growth factors such as EPO and G-CSF before or after collection. Transplanted dose was 1.4-10.8 × 10 8 cells/kg recipient body weight without differences due to donor age. Higher concentrations of nucleated and CD34 + cells were obtained from younger donors. All donors tolerated the procedures well, with no serious complications. Thus, children may safely donate marrow for allogeneic transplantation, and the yields of nucleated cells for engraftment are substantial.Bone Marrow Transplantation (2014) 49, 921-926;

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Section: Discussionmentioning

confidence: 99%

Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion

Yabe

Morimoto

Shimizu

et al. 2014

Bone Marrow Transplant

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“…Uygulama kolaylığı ve relatif düşük maliyete rağmen allojenik kan transfüzyonunun bazı riskleri vardır , 31,32 . Allojenik kan transfüzyonunun akut hemolitik reaksiyon (1/250.000), otoantikorların gelişimi, AİDS (1/200.000), hepatit B ve C (her biri için 1/30.000) gibi enfeksiyon hastalıklarının yayılımı, transfüzyona bağlı akciğer hasarı (1/5000) ve immünosupresyon gibi riskleri bulunmaktadır.…”

Section: Kanama Ve Transfüzyonunclassified

“…Aynı zaman aralığında ortalama arter basıncı değişiklikleri ile kan kaybı arasında negatif bir korelasyon saptanmıştır 6 . Allojenik transfüzyona göre otolog transfüzyon ideal gibi görünmektedir, aynı zamanda allojenik tranfüzyona ait riskler yoktur, ancak bu tekniklerin tümü çocuklarda uygun olmayabilir 31 . Küçük çocuklarda (<30 kg) yetersiz kan volümü nedeniyle uygulaması zordur.…”

Section: Kanama Ve Transfüzyonunclassified

Pediyatrik Kraniofasiyal Cerrahide Anestezik Yaklaşım ve Kan Kaybını Azaltan Yöntemler

Biricik¹,

Güneş²

2015

Arşiv Kaynak Tarama Dergisi

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One of the most common craniofacial congenital abnormalities requiring surgery is craniosynostosis where there is premature fusion of one or more cranial sutures. A thorough assessment of the airway is necessary to enable careful planning of the anesthetic technique for craniofacial surgery. Pediatric craniofacial reconstruction procedures, has been associated with significant morbidity including cardiac arrest, massive transfusion, coagulopathy, severe hypotension, air embolism, largely related to blood loss. Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. Attempts at reducing exposure to allogeneic transfusions, using blood conservation techniques such as controlled hypotension and normovolemic hemodilution, have met with mixed results and are not always practical in small infants. In children undergoing surgical correction of craniosynostosis, pre-treated with erythropoietin, intraoperative tranexamic acid reduces transfusion requirement.

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“…Although traditional bleeding management, consisting of transfusion of autologous blood products, offers a fairly acceptable safety profile, there is strong evidence that transfusion-related side-effects are associated with increased morbidity and mortality in children [4,5]. The rate of death corresponds to two per 100 000 blood products transfused.…”

Section: Bleeding and Blood Transfusion: Morbidity And Mortalitymentioning

confidence: 99%

“…The rate of death corresponds to two per 100 000 blood products transfused. The three main causes of mortality are transfusion-related acute lung injury, transfusion-related acute circulatory overload and hemolytic transfusion reactions with mortality rates as high as 15-30% [5]. Other risks include transfusion-transmitted infection and transfusion-related immunomodulation.…”

Section: Bleeding and Blood Transfusion: Morbidity And Mortalitymentioning

confidence: 99%

Perioperative bleeding management in pediatric patients

Goobie

Haas

2016

Current Opinion in Anaesthesiology

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PURPOSE OF REVIEW Managing the bleeding pediatric patient perioperatively can be extremely challenging. The primary goals include avoiding hypotension, maintaining adequate tissue perfusion and oxygenation, and maintaining hemostasis. Traditional bleeding management has consisted of transfusion of autologous blood products, however, there is strong evidence that transfusion-related side-effects are associated with increased morbidity and mortality in children. Especially concerning is the increased reported incidence of noninfectious adverse events such as transfusion-related acute lung injury, transfusion-related circulatory overload and transfusion-related immunomodulation. The current approach in perioperative bleeding management of the pediatric patient should focus on the diagnosis and treatment of anemia and coagulopathy with the transfusion of blood products only when clinically indicated and guided by goal-directed strategies. RECENT FINDINGS Current guidelines recommend that a comprehensive multimodal patient blood management strategy is critical in optimizing patient care, avoiding unnecessary transfusion of blood and blood product and limiting transfusion-related sideeffects. SUMMARY This article will highlight current guidelines in perioperative bleeding management for our most vulnerable pediatric patients with emphasis on individualized targeted intervention using point-of-care testing and specific coagulation products. Purpose of review Managing the bleeding pediatric patient perioperatively can be extremely challenging. The primary goals include avoiding hypotension, maintaining adequate tissue perfusion and oxygenation, and maintaining hemostasis. Traditional bleeding management has consisted of transfusion of autologous blood products, however, there is strong evidence that transfusion-related side-effects are associated with increased morbidity and mortality in children. Especially concerning is the increased reported incidence of noninfectious adverse events such as transfusion-related acute lung injury, transfusion-related circulatory overload and transfusion-related immunomodulation. The current approach in perioperative bleeding management of the pediatric patient should focus on the diagnosis and treatment of anemia and coagulopathy with the transfusion of blood products only when clinically indicated and guided by goaldirected strategies. Recent findingsCurrent guidelines recommend that a comprehensive multimodal patient blood management strategy is critical in optimizing patient care, avoiding unnecessary transfusion of blood and blood product and limiting transfusion-related side-effects. SummaryThis article will highlight current guidelines in perioperative bleeding management for our most vulnerable pediatric patients with emphasis on individualized targeted intervention using point-of-care testing and specific coagulation products.

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Blood transfusion risks and alternative strategies in pediatric patients

Cited by 180 publications

References 64 publications

Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion

Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion

Pediyatrik Kraniofasiyal Cerrahide Anestezik Yaklaşım ve Kan Kaybını Azaltan Yöntemler

Perioperative bleeding management in pediatric patients

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