Indications for red cell transfusions in pediatric patients.

Autor: Cholette JM; Pediatrics Critical Care, University of Rochester Medical Center, Strong Memorial and Golisano Children's Hospitals, United States; Pediatrics Cardiology, University of Rochester Medical Center, Strong Memorial and Golisano Children's Hospitals, United States. Electronic address: jill_cholette@urmc.rochester.edu., Noronha SA; Pediatrics Hematology-Oncology, University of Rochester Medical Center, Strong Memorial and Golisano Children's Hospitals, United States., Seghatchian J; International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK., Blumberg N; Transfusion Medicine/Blood Bank Division of Pathology and Laboratory Medicine, University of Rochester Medical Center, Strong Memorial and Golisano Children's Hospitals, United States.
Jazyk: angličtina
Zdroj: Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis [Transfus Apher Sci] 2018 Jun; Vol. 57 (3), pp. 342-346. Date of Electronic Publication: 2018 May 10.
DOI: 10.1016/j.transci.2018.05.017
Abstrakt: Red cell transfusions are amongst the most common therapeutic procedures in seriously ill children, particularly in the inpatient setting. This is despite the fact that there is no evidence base for most clinical settings, with the exception of patients with hemoglobinopathies, particularly thalassemia and sickle cell anemia. Obviously exsanguinating hemorrhage and life threatening anemia are urgent indications for which no other therapeutic approach is currently available. Most transfusions are, however, given prophylactically to prevent the complications of hypoxia or hemodynamic stability, based upon expert opinion and a faith in the oxygen carrying capacity and beneficial hemodynamic properties of transfused red cells. The question confronting current day pediatric practice is to what extent transfused red cells prevent adverse events, other than in thalassemia and sickle cell anemia, as opposed to causing them. Do transfusions of red cells prevent organ failure, stroke, etc. or not? There is epidemiologic evidence in the adult randomized trial literature that liberal red cell transfusion likely causes more such adverse events than it prevents. The relevance of such studies to children, particularly neonates, is uncertain. Randomized trials in critically ill neonates have yielded little to no evidence that liberal red cell transfusion is beneficial, but the data are not definitive. In critically ill older children the data suggest there is no benefit to liberal red cell transfusion, but the indications for red cell transfusion are uncertain. Most practitioners would agree that combining laboratory data such hemoglobin/hematocrit with clinical indications for transfusions (evidence of end organ hypoxia such as tachycardia, shortness of breath, etc.) is the only viable strategy at present, until more definitive randomized trial data are available.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: