Abstract
Objective: This study aimed to describe transfusion reactions of pediatric patients from a National Center for Children's Health in China and to examine reaction incidents, reaction types by blood transfusion, and the associated blood products resulting in transfusion reactions.Methods: We compared transfusion reaction rates, among platelets, plasma, and red blood cells (RBCs) using a retrospective analysis of pediatric patients treated with blood transfusion based on data from the National Center for Children's Health (Beijing, China) by a hemovigilance reporting system from January 2015 to December 2019.Results: Over the past 5 years, 165 reactions were reported, and the overall incidence was 1.35‰ (95% CI: 1.14–1.55‰; 165/122,652); for each separate year, the incidences were 1.25‰ (95% CI: 0.76–1.74‰; 25/20,035; 2015), 1.09‰ (95% CI: 0.65–1.52‰; 24/22,084; 2016), 1.66‰ (95% CI: 1.14–2.18‰; 39/23,483; 2017), 1.36‰ (95% CI: 0.92–1.81‰; 36/26,440; 2018) and 1.34‰ (95% CI: 0.93–1.75‰; 41/30,610; 2019). Transfusion reaction incidents by person included 0.37‰ (95% CI: 0.21–0.53‰; 21/56,815) RBCs, 2.98‰ (95% CI: 2.33–3.64‰; 79/26,496) platelets and 1.65‰ (95% CI: 1.25–2.05‰; 65/39,341) frozen plasma. According to the analysis by blood products, the incidence of transfusion was 0.34‰ (95% CI: 0.20–0.48‰; 23/66,958) for RBCs, 3.21‰ (95% CI: 2.50–3.92‰; 78/24,318.5) for platelets, and 0.94‰ (95% CI: 0.71–1.17‰; 64/67,912) for frozen plasma. Transfusion reactions were most commonly associated with platelets, followed by plasma and RBC transfusions. The types of blood transfusion reactions were mainly allergic reactions (86.67%) and febrile non-hemolytic transfusion reactions (FNHTRs, 4.24%). The disease types of pediatric patients with transfusion reactions were concentrated among those with blood system diseases. A total of 80.61% of children with transfusion reactions had a previous blood transfusion history.Conclusions: Transfusion reactions are still relatively common in pediatric patients, and additional studies are necessary to address the differences in reaction rates, especially allergic and FNHTRs. Robust hemovigilance systems do include a special section dedicated to children will further the understanding of these reactions and trends, and prospective randomized clinical controlled trials may need to be conducted to perform preventive and corrective measures.
Highlights
A century ago, pediatric medicine was defined based on its specialty
Clinical guidelines used for adult patients are not fully adapted to pediatric patients in terms of product types, modifications, doses, transfusion indications, blood product selections, potential transfusion reactions
The types of blood transfusion reactions were mainly allergic reactions, FNHTRs, and unknown reactions, which main symptoms included tachycardia, chills, chest tightness and body shaking. These diseases of pediatric patients with transfusion reactions were concentrated among children with blood system diseases, including acute lymphoblastic leukemia, non-Hodgkin’s lymphoma, aplastic anemia, hemophagocytic syndrome, pancytopenia and others, such as Henoch-Schonlein purpura
Summary
A century ago, pediatric medicine was defined based on its specialty. Clinical guidelines used for adult patients are not fully adapted to pediatric patients in terms of product types, modifications, doses, transfusion indications, blood product selections, potential transfusion reactions. Most of pediatric guidelines and consensus guidance (such as pediatric transfusion) are not completely based on studies and clinical practice of children [4, 5]. According to a 2-year cohort study from Peltoniemi et al, there was a significant reduction in mortality when children were treated in pediatric units rather than in adult and child mixed wards [6]. It is necessary to conduct more studies to understand the unique characteristics of the pediatric patient population
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