Recommendations on selection and processing of Red Blood Cell components for pediatric patients from the pediatric critical care transfusion and Anemia expertise initiative

• Type of Material: Article
• Authors: Nicole D Zantek, University of Minnesota Twin Cities; Robert I Parker, Renaissance School of Medicine at Stony Brook University; Leo M Van De Watering, Leiden University Medical Center; Cassandra Josephson, Emory University; Scot T Bateman, University of Massachusetts Medical School; Stacey L Valentine, University of Massachusetts Medical School; Meghan Delaney, Childrens National Health System
• Language: English
• Date: 2018-01-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
• Final Published Version (URL): http://dx.doi.org/10.1097/PCC.0000000000001625
• Title of Journal or Parent Work: Pediatric Critical Care Medicine
• Volume: 19
• Issue: 9
• Start Page: S163
• End Page: S169
• Grant/Funding Information: Dr. Bateman’s institution received funding from R13 conference grant from NICHD and NHLBI and SABM, and he received support for article research from the NIH.; Dr. Van de Watering received funding from the Sanquin Blood Supply Foundation. Dr. Josephson received funding from Immucor (consulting) and Octapharma, and she received support for article research from the NIH/NHLBI.; TAXI was supported, in part, by funding from the National Institutes of Health (NIH) NICHD/NHLBI, Washington University at St Louis Children’s Discovery Institute (CDI), the Society for the Advancement of Blood Management (SABM), the University of Massachusetts, and the CHU-Sainte Justine Foundation as well as support from the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.; Dr. Valentine’s institution received funding from NICHD and NHLBI under award number 1 R13 HD088086-01; the Society for the Advancement of Blood Management SABM-Haemonetics Research Starter Grant; and Washington University Children’s Discovery Institute (DCI-E1-2015-499). She received other support from CHU-Sainte-Justine Foundation and the University of Massachusetts Medical School, and she received support for article research from the NIH, SABM SABM-Haemonetics Research Starter Grant, CHU-Sainte-Justine Foundation, Washington University CDI, and the University of Massachusetts Medical School.; Dr. Zantek’s institution received research funding from Terumo BCT, Octapharma, and Bayer HealthCare; she received funding from Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Heart, Lung, and Blood Institute (NHLBI) R13 (1 R13 HD088086-012)
• Keywords: Transfusion Reaction; Graft vs Host Disease; Child; Erythrocyte Transfusion; Intensive Care Units, Pediatric; Humans; Anemia; Critical Care; Critical Illness; IgA Deficiency; Evidence-Based Medicine
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

Objectives: To present the recommendations and supporting literature for selection and processing of RBC products in critically ill children developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Design: Consensus conference series of international, multidis-ciplinary experts in RBC transfusion management of critically ill children Methods: The panel of 38 experts developed evidence-based, and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The RBC processing subgroup included five experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases jrom 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. Results: Five recommendations reached agreement (> 80%). Irradiated cellular products are recommended for children at risk of transfusion-associated graft versus host disease due to severe congenital or acquired causes of immune deficiency or when the blood donor is a blood relative. Washed cellular blood components and avoidance of other plasma-containing products are recommended for critically ill children with history of severe allergic reactions or anaphylaxis to blood transfusions, although patient factors appear to be important in the pathogenesis of reactions. For children with history of severe allergic transfusion reactions, evaluation for allergic stigmata prior to transfusion is recommended. In children with severe immunoglobulin A deficiency with evidence of antiimmunoglobulin A antibodies and/or a history of a severe transfusion reaction, immunoglobulin A-deficient blood components obtained either jrom an immunoglobulin A-deficient donor and/or washed cellular components is recommended. Conclusions: The Transfusion and Anemia Expertise Initiative consensus conference developed recommendations for selection and processing of RBC units for critically ill children. Recommendations in this area are largely based on pediatric and adult case report data.