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.
Bibliographical noteFunding Information:
1Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN. 2Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY. 3Sanquin - Leiden University Medical Centre, Center for Clinical Transfusion Research, Leiden, The Netherlands. 4Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University of Medicine, Atlanta, GA. 5Aflac Cancer Center and Blood Disorders Service, Department of Pediatrics, Emory University of Medicine, Atlanta, GA. 6Division of Pediatric Critical Care, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA. 7Division of Pathology and Laboratory Medicine, Children’s National Health System, Washington, DC. 8George Washington University, Washington, DC. Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI) members are listed in Appendix 1. 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. 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); she disclosed that she is on the College of American Pathologist Transfusion Medicine Resource Committee of the American Society for Apheresis Inbound Liaison and 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. van de Watering received funding from the Sanquin Blood Supply Foundation. Dr. Josephson received funding from Immucor (consulting), Biomet
Zimmer, and Octapharma, and she received support for article research from the National Institutes of Health (NIH)/NHLBI. Dr. Bateman’s institution received funding from R13 conference grant from NICHD and NHLBI and the Advancement of Blood Management (SABM), and he received support for article research from the NIH. 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 (CDI-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-Haemonetics Research Starter Grant, CHU-Sainte-Justine Foundation, Washington University CDI, and the University of Massachusetts Medical School. Dr. Delaney received unrelated funding from Sio Capital (consulting about blood bank instrument), Janssen (consulting about blood bank testing for cancer patients), and Grifols (teaching about blood bank molecular testing). Dr. Parker has disclosed that he does not have any potential conflicts of interest.
- Allergic reaction
- Consensus development conference
- Critical illness
- Graft versus host disease
- Immunoglobulin A deficiency