Plasma and Platelet Transfusion Strategies in Critically Ill Children With Malignancy, Acute Liver Failure and/or Liver Transplantation, or Sepsis: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

Lani Lieberman, Oliver Karam, Simon J. Stanworth, Susan M. Goobie, Gemma Crighton, Ruchika Goel, Jacques Lacroix, Marianne E. Nellis, Robert I. Parker, Katherine Steffen, Paul Stricker, Stacey L. Valentine, Marie E. Steiner

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Abstract

OBJECTIVES: To present the consensus statements with supporting literature for plasma and platelet transfusions in critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding. DESIGN: Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children. SETTING: Not applicable. PATIENTS: Critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A panel of 13 experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed 12 expert consensus statements. CONCLUSIONS: In the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding program, the current absence of evidence for use of plasma and/or platelet transfusion in critically ill children with malignancy, acute liver disease and/or following liver transplantation, and sepsis means that only expert consensus statements are possible for these areas of practice.

Original languageEnglish (US)
Pages (from-to)e37-e49
JournalPediatric Critical Care Medicine
Volume23
Issue numberSupplement 1 1S
DOIs
StatePublished - Jan 1 2022

Bibliographical note

Funding Information:
The Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding was supported, in part, by the National Institutes of Health National Heart, Lung and Blood Institute under award number R13 HL154544-01.

Funding Information:
We would like to thank all members of the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding for their support and input, especially during the coronavirus disease 2019 pandemic. In addition, we thank the Chaire H?ma-Qu?bec-Bayer en m?decine transfusionnelle de l'Universit? de Montr?al, the Society for the Advancement of Blood Management, the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, the International Society of Blood Transfusion, the Society for Critical Care Medicine, and the AABB for their support.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

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