There have been recent advances in safer blood component preparation and use of adjuvant blood derivatives, which have limited safety and efficacy data on use in children. This article reviews the literature on use of whole blood, solvent/detergent-treated plasma, pathogen-reduced platelets, and fibrinogen concentrate in pediatric patients. Many countries have adopted pathogen-reduced blood product technology, and hospitals in the United States are slowly adopting these products. The pediatric transfusion medicine community needs to appraise the evidence for their use and continue to advocate the inclusion of children in the most robust randomized clinical trials for novel blood components.
There are limited data available on the safety and efficacy of new blood preparation techniques, such as pathogen reduction, and adjuvant therapies, such as fibrinogen concentrate, in children.
Whole blood, which was historically used more frequently in infants and children undergoing cardiopulmonary bypass surgery, is being used in new clinical scenarios, including trauma resuscitation.
Prospective, randomized clinical trials in larger numbers of children are needed to further characterize the safety and clinical efficacy of novel blood component therapies, especially because wider use is expected.
The dogma of transfusion medicine for the last several decades has been the use of blood component therapy; that is, packed red blood cells (RBCs), platelets, and plasma and cryoprecipitate for the treatment or prevention of anemia, thrombocytopenia and hypocoagulability or bleeding, and hypofibrinogenemia, respectively. Recently there has been a surge in both new preparation techniques to make existing blood components safer, such as pathogen reduction, and the use of adjuvant treatments, such as fibrinogen concentrate, to prevent bleeding and subsequent use of blood components. Although these newer blood products or blood derivatives have been studied and used more often in adult patients, this article reviews these products and the existing literature regarding their safety and efficacy in children because their use is likely to become more common:
Whole blood (WB)
Solvent/detergent-treated blood products, such as Octoplas
Pathogen-reduced (PR) blood products, such as INTERCEPT and Mirasol platelet components
WB is not a new product or technique but is the foundation of transfusion medicine that is making a resurgence, especially in trauma resuscitation. WB was initially described in the early 1990s for use in children undergoing complex cardiac surgery, and additional studies of its use in pediatric trauma and other pediatric surgeries have been recently described .