Transfusions in the Critically Ill Pediatric Patient

Jelena Roganovic

Disclosures

Pediatr Health. 2010;4(2):201-208. 

In This Article

Special Considerations

Special considerations should always be given to neonates, stem cell transplantation (SCT) candidates and immunocompromised children. Neonatal transfusion strategies have already been discussed. All children with aplastic anemia, or who are being treated with high-dose chemotherapy and/or radiotherapy, may become candidates for SCT. These children should receive leukoreduced RBCs and platelet transfusions. Irradiation is recommended for use as follows: for 2 weeks before all types of SCT and during conditioning for all types of SCT, or whichever is longer, for 7 days prior to the harvesting of autologous bone marrow or peripheral blood stem cells, 3 months postautologous SCT, indefinitely in allogeneic SCTs and where blood products from relatives are being used.[16]

There are no clear evidence-based criteria for the administration of RBC transfusions in this group of patients. Therefore, the decision depends on clinical judgment, taking into account the child's condition, comorbidities, the presence of bleeding and the probability of hematologic recovery. For children with cancer, RBC transfusion is generally required when the Hb concentration falls below 7 g/dl. For children with aplasia, RBC transfusions are reserved for symptomatic patients with Hb values of less than 7 g/dl, since sensitization to large numbers of transfusions reduces the chance of a successful outcome.[16,19]

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