Recommendations on RBC transfusion support in children with hematologic and oncologic diagnoses from the pediatric critical care transfusion and anemia expertise initiative

Marie E. Steiner, Nicole D. Zantek, Simon J. Stanworth, Robert I. Parker, Stacey L. Valentine, Leslie E. Lehmann, Cassandra D. Josephson, Scot T. Bateman, Naomi L.C. Luban

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Objectives: To present the recommendations and supporting evidence for RBC transfusions in critically ill children with hema-tologic and oncologic disease jrom the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Design: Consensus conference series of international, multidisciplinary 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 and research priorities for RBC transfusions in critically ill children. The hematologic/oncologic subgroup included seven 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: The hematologic/oncologic subgroup developed 14 recommendations (seven clinical, seven research); all achieved greater than 80% agreement. In patients with sickle cell disease, Transfusion and Anemia Expertise Initiative recommends: 1) RBC transfusion to achieve a target hemoglobin concentration of 10 g/dL rather than hemoglobin of less than 30% prior to surgical procedures requiring general anesthesia and 2) exchange transfusion over simple (nonexchange) transfusion if the child's condition is deteriorating (based on clinical judgment), otherwise a simple, nonexchange RBC transfusion is recommended. There is insufficient evidence to make recommendations on transfusion thresholds for patients with sickle cell disease prior to minor procedures, with acute stroke or with pulmonary hypertension. For patients with oncologic disease or undergoing hematopoietic stem cell transplant, a hemoglobin concentration of 7-8 g/dL is recommended. Due to lack of evidence, research is needed to clarify the appropriate transfusion thresholds in these patients. Conclusions: Transfusion and Anemia Expertise Initiative developed specific pediatric recommendations regarding RBC transfusion management in critically ill children with sickle cell disease, oncologic disease, and hematopoietic stem cell transplant and recommendations to help guide future research priorities.

Original languageEnglish (US)
Pages (from-to)S149-S156
JournalPediatric Critical Care Medicine
Volume19
Issue number9
DOIs
StatePublished - 2018

Bibliographical note

Funding Information:
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal). The Transfusion and Anemia Expertise Initiative was supported, in part, by the National Institutes of Health 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, the Society for the Advancement of Blood Management (SABM)-Haemonetics Research Starter Grant, the CHU-Sainte-Justine Foundation, the Washington University Children's Discovery Institute (CDI-E1-2015-499), and the University of Massachusetts Medical School. Drs. Steiner, Zantek, Valentine, and Josephson received support for article research from the National Institutes of Health (NIH). Dr. Steiner received funding from NIH R13 grant from the National Institute of Child Health and Human Development (NICHD) and National Heart, Lung, and Blood Institute (NHLBI). Dr. Zantek's institution received research funding from Terumo BCT, Octapharma, and Bayer HealthCare and received funding from the NICHD/NHLBI R13 (1 R13 HD088086-012) (received travel funds to attend one of the consensus conference meetings) and the College of American Pathologist Transfusion Medicine Resource Committee - American Society for Apheresis Inbound Liaison (travel expenses paid by ASFA), and she disclosed that she is an Executive Board Member for the North American Specialized Coagulation Laboratory Association and her spouse is an employee of Boston Scientific and owns stock in ENDO International PLC. Dr. Zantek disclosed that Transfusion and Anemia Expertise Initiative was supported, in part, by funding from the NIH NICHD/NHLBI, Washington University at St Louis CDI, Society for the Advancement of Blood Management (SABM), the Canadian Critical Care Trials Group, the University of Massachusetts, as well as support from the Pediatric Acute Lung Injury and Sepsis Investigators Network and the World Federation of Pediatric Intensive and Critical Care Society. Dr. Valentine also received support for article research from Washington University Children's Discovery Institute Grant (CDI-E1-2015-499), the University of Massachusetts Medical School, the SABM SABM-Haemonetics Research Starter Grant, and the CHU-Sainte Justine Foundation. Dr. Valentine's institution received funding from Eunice Kennedy Shriver NICHD and NHLBI under award number 1 R13 HD088086-01, the Society for the Advancement of Blood Management SABM-Haemonetics Research Starter Grant, Washington University Children's Discovery Institute (CDI-E1-2015-499), and she received other support from CHU-Sainte-Justine Foundation and the University of Massachusetts Medical School. Dr. Josephson received funding from Immucor, Inc (consultancy) and Octapharma (consultancy). Dr. Luban disclosed other support from Cellphire (consultant, two NIH DSMBs) and from the AABB (travel). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Funding Information:
Drs. Steiner, Zantek, Valentine, and Josephson received support for article research from the National Institutes of Health (NIH). Dr. Steiner received funding from NIH R13 grant from the National Institute of Child Health and Human Development (NICHD) and National Heart, Lung, and Blood Institute (NHLBI). Dr. Zantek’s institution received research funding from Terumo BCT, Octapharma, and Bayer HealthCare and received funding from the NICHD/NHLBI R13 (1 R13 HD088086-012) (received travel funds to attend one of the consensus conference meetings) and the College of American Pathologist Transfusion Medicine Resource Committee—American Society for Apheresis Inbound Liaison (travel expenses paid by ASFA), and she disclosed that she is an Executive Board Member for the North American Specialized Coagulation Laboratory Association and her spouse is an employee of Boston Scientific and owns stock in ENDO International PLC. Dr. Zantek disclosed that Transfusion and Anemia Expertise Initiative was supported, in part, by funding from the NIH NICHD/NHLBI, Washington University at St Louis CDI, Society for the Advancement of Blood Management (SABM), the Canadian Critical Care Trials Group, the University of Massachusetts, as well as support from the Pediatric Acute Lung Injury and Sepsis Investigators Network and the World Federation of Pediatric Intensive and Critical Care Society. Dr. Valentine also received support for article research from Washington University Children’s Discovery Institute Grant (CDI-E1-2015–499), the University of Massachusetts Medical School, the SABM SABM-Haemonetics Research Starter Grant, and the CHU-Sainte Justine Foundation. Dr. Valentine’s institution received funding from Eunice Kennedy Shriver NICHD and NHLBI under award number 1 R13 HD088086-01, the Society for the Advancement of Blood Management SABM-Haemonetics Research Starter Grant, Washington University Children’s Discovery Institute (CDI-E1-2015–499), and she received other support from CHU-Sainte-Justine Foundation and the University of Massachusetts Medical School. Dr. Josephson received funding from Immucor, Inc (consultancy) and Octapharma (consultancy). Dr. Luban disclosed other support from Cellphire (consultant, two NIH DSMBs) and from the AABB (travel). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: stein083@umn.edu

Funding Information:
The Transfusion and Anemia Expertise Initiative was supported, in part, by the National Institutes of Health 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, the Society for the Advancement of Blood Management (SABM)-Haemonetics Research Starter Grant, the CHU-Sainte-Justine Foundation, the Washington University Children’s Discovery Institute (CDI-E1-2015–499), and the University of Massachusetts Medical School.

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

Keywords

  • Cancer
  • Child
  • Pediatric critical care
  • Red blood cell
  • Sickle cell disease
  • Stem cell transplant

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