Pediatrics & Neonatology
Volume 49, Issue 2 , Pages 5-12, April 2008

Transfusion Therapy in Critically Ill Children

  • Tai-Tsung Chang

      Affiliations

    • Corresponding Author InformationCorresponding author. Pediatric Hematology/Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung 807, Taiwan

Pediatric Hematology/Oncology, Kaohsiung Medical University Hospital and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Received 28 September 2007; received in revised form 17 December 2007; accepted 25 March 2008.

Article Outline

Critically ill children in pediatric intensive care units are commonly indicated for blood transfusion due to many reasons. Children are quite different from adults during growth and development, and that should be taken into consideration. It is very dif-ficult to establish a universal transfusion guideline for critically ill children, especially preterm neonates. Treating underlying disease and targeted replacement therapy are the most effective approaches. Red blood cells are the first choice for replacement therapy in decompensated anemic patients. The critical hemoglobin concentration may be higher in critically ill children for many reasons. Whole blood is used only in the following conditions or diseases: (1) exchange transfusion; (2) after cardiopulmonary bypass; (3) extracorporeal membrane oxygenation; (4) massive transfusion, especially in multiple component deficiency. The characteristics of hemorrhagic diseases are so varied that their therapy should depend on the specific needs associated with the underlying disease. In general, platelet transfusion is not needed when a patient has platelet count greater than 10,000/mm3 and is without active bleeding, platelet functional deficiency or other risk factors such as sepsis. Patients with risk factors or age less than 4 months should be taken into special consideration, and the critical thrombocyte level will be raised. Platelet transfusion is not recommended in patients with immune-mediated thrombocytopenia or thrombocytopenia due to acceleration of platelet destruction without active bleeding or life-threatening hemorrhage. There are many kinds of plasma-derived products, and recombinant factors are commonly used for hemorrhagic patients due to coagulation factor deficiency depending on the characteristics of the diseases. The most effective way to correct disseminated intravascular coagulation (DIC) is to treat the underlying disease. Anticoagulant ther-apy is very important; heparin is the most common agent used for DIC but the results are usually not satisfactory. Antithrombin III, protein C, or recombinant thrombomodu-lin has been used successfully to treat this condition. For reducing the risk of organism transmission and adverse reactions resulting from blood transfusion, the following measures have been suggested: (1) replacement therapy using products other than blood (e.g., erythropoietin, iron preparation, granulocyte colony-stimulating factor); (2) special component replacement therapy for specific diseases; (3) autotransfusion; (4) subdividing whole packed blood products into smaller volumes to reduce donor exposure; (5) advances in virus-inactivating procedures. To avoid viral transmission, vapor-heated or pasteurized products and genetic recombinant products are recom-mended. Cytomegalovirus (CMV)-seronegative blood, leukoreduced and/or irradiated blood are recommended for prevention of CMV infection, graft-versus-host-disease and alloimmunization in neonate and immunocompromised patient transfusion. There is no reason to prescribe a plasma product for nutritional supplementation because of the risk of complications. The principle: complications of transfusion must be avoided, the rate of blood exposure should be reduced and the safety of the transfused agents or components should be maintained must always be kept in mind.

KEY WORDS:  blood components , critically ill patient , transfusion

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Chang TT . Blood component therapy in pediatrics . Acta Paed Sin (Suppl A) . 1995;36:30–41
  2. Desmet L , Lacroix J . Transfusion in pediatrics . Crit Care Clin . 2004;20:229–311
  3. Nahum E , Ben-Ari J , Schonfeld  . Blood transfusion policy among European pediatric intensive care physicians . Intensive Care Med . 2004;19:38–43
  4. Dani C , Pezzati M , Matelli E , Prussi C , Bertini G , Rubaltelli FF . Effect of blood transfusion on cerebral haemodynamic in preterm infants . Acta Paediatr . 2002;91:938–941
  5. Sloan SR , Benjamin RJ , Friedman DF , Webb IJ , Silberstein L . Transfusion medicine . In: Nathan & Oski's Textbook of Hematology of Infancy and Childhood . 6th ed.. Philadelphia: Saunders; 2003;p. 1709–1756
  6. Jacobs BR , Lyons K , Brilli RJ . Erythropoietin therapy in children with bronchiolitis and anemia . Pediatr Crit Care Med . 2003;4:123–124
  7. Laverdiere C , Gauvin F , Hebert PC , et al.   Canadian Critical Care Trials Group. Survey on transfusion practices of pediatric intensivists . Pediatr Crit Care Med . 2002;3:335–340
  8. In:  Sun CF editors. Transfusion Medicine . 1st ed.. Taipei: Landes Bioscience; 2003; Chapter 4: Rh type, p. 43–58; Chapter 12: Blood components, p. 161–216; Chapter 20: Hemolytic disease of newborn, p. 257–72.
  9. Broadberry RE , Lin M . The distribution of the MiIII(GP.Mur) phenotype among the population of Taiwan . Transfusion Med . 1996;6:145–148
  10. Obladen M , Sachsenweger M , Stahnke M . Blood sampling in very low birth-weight infants receiving different levels of intensive care . Eur J Pediatr . 1988;147:399–404
  11. Madsen LP , Rasmussen MK , Bjerregaard LL , Nohr SB , Ebbesen F . Impact of blood sampling in very preterm infants . Scand J Clin Lab Invest . 2000;60:125–132
  12. Krafte-Jacobs B , Levetown ML , Bray GL , Ruttimann UE , Pollack MM . Erythropoietin response to critical illness . Crit Care Med . 1994;22:821–826
  13. Strauss RG . Blood and blood component transfusions . In:  Behrman RE ,  Kliegman RM ,  Jenson HB editor. Nelson Textbook of Pediatrics . 16th ed.. Philadelphia: WB Saunders; 2000;p. 1499–1503 Section 6, Chapters 476–480.
  14. Ringer SA , Richardson DK , Sacher RA , Keszler M , Churchill WH . Variations in transfusion practice in neonatal intensive care . Pediatrics . 1998;101:194–200
  15. Lacroix J , Nadeau D , Laberge S , Gauthier M , Lapierre G , Farrell CA . Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit . Crit Care Med . 1992;20:35–42
  16. McGrady GA , Rettig PJ , Istre GR , Jason JM , Holmann RC , Evatt BL . An outbreak of necrotizing enterocolitis association with transfusions of packed red cells . Am J Epidemiol . 1987;126:1165–1172
  17. Donowitz LG , Turner RB , Searcy MAM , Luban NLC , Hendley OH . The high rate of blood exposure for critically ill neonates . Hosp Epidemiol . 1989;10:509–510
  18. Bifano EM , Curran TR . Minimizing donor blood exposure in the neonatal intensive care unit . Perinatal Hematol . 1995;22:657–669
  19. Stoll BJ , Kliegman RM . Hemolytic disease of newborns . In:  Behrman RE ,  Kliegman RM ,  Jenson HB editor. Nelson Textbook of Pediatrics . 16th ed.. Philadelphia: WB Saunders; 2000;p. 521–525 Chapter 99
  20. Fergusson D , Hébert PC , Lee SK , et al.   Clinical outcomes following institution of universal leukoreduction of blood transfusion for premature infants . JAMA . 2003;16:1993–1995
  21. Murray NA . Evaluation and treatment of thrombocytopenia in the neonatal intensive care unit . Acta Paediatr . 2002;438(Suppl):74–81
  22. Chevuru SC , Sola MC , Theriaque DW , et al.  Florida Collaborative Neonatology Research Group   Multicenter analysis of platelet transfusion usage among neonates on extracorporeal membrane oxygenation . Pediatrics . 2002;109:e89
  23. Kahn DJ , Richardson DK , Billett HH . Inter-NICU variation in rates and management of thrombocytopenia among very low birthweight infants . J Perinatol . 2003;23:312–316
  24. Garcia MG , Duenas E , Sola MC , Hutson AD , Theriaque D , Christensen RD . Epidemiology and outcome studies of patients who received platelet transfusions in the neonatal intensive care unit . Perinatol . 2001;21:415–420
  25. Del Vecchio A , Sola MC , Theriaque D , et al.   Platelet transfusions in the neonatal intensive care unit: factors predicting which patients will require multiple transfusion . Transfusion . 2001;41:803–808
  26. Robert IA , Murray NA . Neonatal thrombocytopenia: new insights into pathogenesis and implications for clinical management . Curr Opin Pediatr . 2001;13:16–21
  27. Maruyama I . Recombinant thrombomodulin and activated protein C in the treatment of disseminated intravascular coagulation . Thromb Haemost . 1999;82:718–721
  28. Strauss RG . Therapeutic granulocyte transfusions in 1993 . Blood . 1993;81:1675
  29. Strauss RG . Granulocytes transfusions . In:  Rossi EC ,  Simon TL ,  Moss GS editor. Principle of Transfusion Medicine . 2nd ed.. Baltimore: Williams & Wilkins; 1996;p. 321
  30. Griffin MP , O'Shea M , Brazy JE , Klein D , Koepke J , Wilfert CM . Cytomegalovirus infection in a intensive care unit: subsequent morbidity and mortality of seropositive infants . J Perinatol . 1990;10:43–45
  31. Weston PJ , Farmer K , Groxson MC , Ramirez AM . Morbidity from acquired cytomegalovirus infection in a neonatal intensive care unit . Aust Paediatr J . 1989;25:138–142
  32. Hubert C , Janot C , George JC , van Melkebecke E , Andre M , Vert P . Post-transfusion cytomegalovirus infection in premature infants weighing less than 1500 g . Pediatrics . 1989;44:471–479
  33. Munoz PE , Herruzo CR , Garcia CJ , Femandez AM , Quero J . Nosocomial infection over three years in a neonatal intensive care unit: multivariate study . Med Clin (Barc) . 1997;109:527–531

PII: S1875-9572(08)60004-2

doi:10.1016/S1875-9572(08)60004-2

Pediatrics & Neonatology
Volume 49, Issue 2 , Pages 5-12, April 2008

Article Tools