Preventing adverse reactions in pediatric transfusions using washed platelet concentrate

Abstract

Blood transfusion is an important form of supportive care in children; however, transfusion-associated adverse reactions (TARs) are a problem. As with adults, allergic transfusion reactions (ATRs) and febrile non-hemolytic transfusion reactions (FNHTRs) are major TARs, and the frequency of ATRs caused by platelet concentrate (PC) tends to be particularly high. The plasma component of the blood product is thought to be a major factor in the onset of TARs such as ATR and FNHTR. By contrast, in children, age, underlying disease, and number of blood transfusions may be relevant patient-related factors. Although acetaminophen or diphenhydramine may be used prophylactically to prevent TARs, there is no clear evidence of their effectiveness. Volume-reduced PC is used to prevent TARs; however, it may be difficult to maintain the quality of platelets. Plasma-replaced PC stored with platelet additive solution raises the concern that TARs cannot be completely prevented by residual plasma. Washed PC removes most of the plasma, so it can effectively prevent ATR and FNHTR. The recent development of platelet additive solution [M-sol, bicarbonate Ringer's solution supplemented with acid-citrate-dextrose formula A (BRS-A)] in Japan has enabled the maintenance of the quality of platelets for long periods. The clinical use of washed PC in Japan has therefore progressed. Washed PC with M-sol or BRS-A for pediatric patients can effectively prevent TARs without diminishing the transfusion effect. The supply of washed PC has begun from the Japanese Red Cross Society, and it has become possible to use washed PC at all medical institutions in Japan.

Relationship between allergic transfusion reactions and allergic predisposition among pediatric patients with hematological/oncological disease

“…However, it is interesting to note that pollen may be directly involved in ATR development. This concept may also be useful in elucidating the clinical mechanism of ATRs, which develop particularly frequently due to platelet products 3,7 …”

“…Thus, prediction of ATR development before transfusion is difficult. If an ATR occurs without an improvement in the symptoms with medications, it may be necessary to discard the relevant blood product and reorder another blood product 3 . Previous studies have suggested that ATR onset cannot be attributed to a single factor, but is caused by a combination of various factors, including donor‐ and product‐derived factors as well as patient‐related factors 2–4 …”

“…With respect to patient‐related factors, pediatric patients have been reported to show a higher incidence of ATRs than adults 5,6 . Furthermore, patients' disease, age, sex, number of transfused products, and past history of ATRs are related to the onset of ATRs in children 3,7,8 . Especially in patients with hematological and oncological disease, ATRs may occur with a particularly high frequency after transfusion of both platelet and red blood cell products 3,7 .…”

“…If an ATR occurs without an improvement in the symptoms with medications, it may be necessary to discard the relevant blood product and reorder another blood product. 3 Previous studies have suggested that ATR onset cannot be attributed to a single factor, but is caused by a combination of various factors, including donor-and productderived factors as well as patient-related factors. [2][3][4] With respect to patient-related factors, pediatric patients have been reported to show a higher incidence of ATRs than adults.…”

“…3 Previous studies have suggested that ATR onset cannot be attributed to a single factor, but is caused by a combination of various factors, including donor-and productderived factors as well as patient-related factors. [2][3][4] With respect to patient-related factors, pediatric patients have been reported to show a higher incidence of ATRs than adults. 5,6 Furthermore, patients' disease, age, sex, number of transfused products, and past history of ATRs are related to the onset of ATRs in children.…”