Children require transfusion of blood components for a vast array of medical conditions, including acute hemorrhage, hematologic and nonhematologic malignancies, hemoglobinopathy, and allogeneic and autologous stem cell transplant. Evidence-based literature on pediatric transfusion practices is limited, particularly for non–red blood cell products, and many recommendations are extrapolated from studies in adult populations. Recognition of these knowledge gaps has led to increasing numbers of clinical trials focusing on children and establishment of pediatric transfusion working groups in recent years. This article reviews existing literature on pediatric transfusion therapy within the larger context of analogous data in adult populations.
Pediatric transfusion practices are highly variable because of the limited amount of evidence-based literature and challenges surrounding development and implementation of standardized guidelines.
A restrictive red blood cell transfusion threshold of 7 g/dL is generally considered to be safe for stable, nonbleeding, critically ill children.
Recommended platelet transfusion thresholds for adults may not be appropriate in pediatric populations because children seem to have a higher risk of clinically significant bleeding independent of platelet count.
Prophylactic plasma transfusion in children is not effective for correction of mild coagulopathy and unnecessarily increases the risk of transfusion-related adverse events.
Transfusion therapy represents a valuable treatment modality for a variety of medical conditions, including acute blood loss and selective deficiency of 1 or more cell lines. Because most blood components cannot be synthetically manufactured, they represent a finite and limited resource that must be wisely used, especially because the United States and other countries largely rely on volunteer blood donors. Indications for the use of blood components have evolved over the last half century with increasing emphasis placed on practices rooted in firm scientific principles in recent decades. To this end, numerous studies have been conducted in order to expand this database and optimize transfusion therapy in various patient populations. Several notable randomized controlled trials investigating liberal versus restrictive red blood cell (RBC) transfusion thresholds , have proved to be particularly influential in changing clinical perceptions. These studies have led to the development of evidence-based transfusion guidelines in adult populations. Patient blood management (PBM) initiatives promote adherence to such guidelines and emphasize assessment of both the risks and benefits of blood product use before transfusion. Establishment of similar guidelines for pediatric patients has been challenging because of the paucity of data from rigorous studies and hesitation associated with conducting research on vulnerable patient populations. Although increased awareness of the knowledge gaps has driven further research, a significant number of pediatric transfusion practices are still based on historical or anecdotal data or are derived from data extrapolated from adult populations. This article provides an overview of the evidence available to date regarding pediatric transfusion guidelines.