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Author Notes:

Stacey Valentine, MD, Department of Pediatrics, H5-524, 55 Lake Ave North, Worcester, MA 01655, 774-442-2164 (phone), 774-443-2062 (fax), Stacey.valentine@umassmemorial.org.

We thank all members of TAXI for their support and their comments.

We also thank the World Federation of Pediatric Intensive and Critical Care Societies; Society for Critical Care Medicine; and the AABB for their support of TAXI.

Dr. Zantek has the following disclosures not related to this project: Octapharma, Terumo BCT, Bayer HealthCare (research funding); Endo International PLC, Boston Scientific (financial interest); North American Specialized Coagulation Laboratory Association (executive board).

Dr. Josephson has the following disclosures not related to this project: consultant for Biomet Zimmer, Immuncor and Octapharma.

The other authors have no relevant disclosures.

Authors' conflicts of interest available in full text.


Research Funding:

The Transfusion and Anemia Expertise Initiative was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Heart, Lung, and Blood Institute under award number 1 R13 HD088086-01; Society for the Advancement of Blood Management SABM-Haemonetics Research Starter Grant; CHU-Sainte-Justine Foundation; Washington University Children’s Discovery Institute (DCI-E1-2015-499); and the University of Massachusetts Medical School.

Dr. Bembea received support from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number K23NS076674.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Critical Care Medicine
  • Pediatrics
  • General & Internal Medicine
  • blood
  • child
  • consensus development conference
  • pediatric critical care
  • red blood cell
  • transfusion
  • LUNG

Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

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Journal Title:

Pediatric Critical Care Medicine


Volume 19, Number 9


, Pages 884-898

Type of Work:

Article | Post-print: After Peer Review


Objectives: To date, there are no published guidelines to direct RBC transfusion decision-making specifically for critically ill children. We present the recommendations from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Design: Consensus conference series of multidisciplinary, international experts in RBC transfusion management of critically ill children. Setting: Not applicable. Intervention: None. Subjects: Children with, or children at risk for, critical illness who receive or are at risk for receiving a RBC transfusion. Methods: A panel of 38 content and four methodology experts met over the course of 2 years to develop evidence-based, and when evidence lacking, expert consensus-based recommendations regarding decision-making for RBC transfusion management and research priorities for transfusion in critically ill children. The experts focused on nine specific populations of critically ill children: general, respiratory failure, nonhemorrhagic shock, nonlife-threatening bleeding or hemorrhagic shock, acute brain injury, acquired/congenital heart disease, sickle cell/oncology/transplant, extracorporeal membrane oxygenation/ventricular assist/renal replacement support, and alternative processing. Data to formulate evidence-based and expert consensus recommendations were selected based on searches of PubMed, EMBASE, and Cochrane Library from 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. Measurements and Results: The Transfusion and Anemia Expertise Initiative consensus conference developed and reached consensus on a total of 102 recommendations (57 clinical [20 evidence based, 37 expert consensus], 45 research recommendations). All final recommendations met agreement, defined a priori as greater than 80%. A decision tree to aid clinicians was created based on the clinical recommendations. Conclusions: The Transfusion and Anemia Expertise Initiative recommendations provide important clinical guidance and applicable tools to avoid unnecessary RBC transfusions. Research recommendations identify areas of focus for future investigation to improve outcomes and safety for RBC transfusion.

Copyright information:

Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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