Blood Transfusion In Children Research Articles

Immunological Consequences of Blood Transfusion in Pediatric Severe Malaria Patients Living with HIV: A Narrative Review

Pediatric severe malaria, often exacerbated by coexisting HIV infection, presents a formidable health challenge, necessitating blood transfusion as a life-saving intervention. This review explores the intricate immunological consequences of blood transfusion in children grappling with the dual burden of severe malaria and HIV. The immunopathogenesis of severe malaria, compounded by the immunosuppressive nature of HIV, sets the stage for complex interactions that impact the immune response to transfused blood. We delve into the immunological alterations induced by severe malaria and HIV individually, elucidating the potential synergistic effects when coexisting. Further, the review scrutinizes the implications of blood transfusion on the immune system of pediatric patients, examining donor-related factors and the immunomodulatory properties of stored blood. The inherent challenge lies in balancing the imperative need for transfusion with the potential risks of exacerbating immune dysregulation. Strategies for clinical management are discussed, emphasizing the importance of personalized approaches to optimize therapeutic outcomes.

Abstract 12339: Erythropoietin Use in Pediatric Ventricular Assist Device Patients

Background: Anemia is common in pediatric ventricular assist device (VAD) patients. Erythropoietin (EPO) has been used to reduce blood transfusions in children after VAD placement. A study in adults showed EPO use after left VAD implantation was associated with higher rates of suspected pump thrombosis. No studies have evaluated the use of EPO in pediatric patients receiving VAD support. Objectives: We aim to assess EPO use in all pediatric patients who underwent placement of a VAD and to assess outcomes for children who received EPO compared to those who did not. Methods: We identified patients from the Pediatric Health Information System who underwent VAD placement from 2010-2020. Use of EPO was described across all sites. Cohorts were compared to assess differences in blood transfusions received post-VAD, incidence of stroke and pump-exchange. Multivariable Cox proportional hazard and logistic regression models were constructed to adjust for confounding factors for outcomes of VAD exchange and stroke, respectively. Results: A total of 1260 patients were included, of which 336 (27%) received EPO. Patients who received EPO were younger (median 3.5y vs. 9y, p<0.001) and more likely to have congenital heart disease (55% vs. 45%, p=0.002). Patients on EPO received fewer blood transfusions compared to those not on EPO [median 0/month (IQR 0-0.9) vs. 0/month (IQR 0-2.3), p<0.001]. VAD exchange and stroke were more common in patients on EPO (10.1% vs. 5.5%, p=0.004 and 37.8% vs. 25%, p<0.001, respectively). After adjusting for confounding factors, the use of EPO was not independently associated with the need for VAD exchange (adjusted hazard ratio 1.2, 95% confidence 0.78 - 1.9, p=0.378). However, EPO remained independently associated with stroke during the hospitalization (adjusted hazard ratio 1.6, 95% confidence 1.2 - 2.1, p=0.002). Conclusion: EPO was used in approximately 1 out of 4 pediatric VAD patients. Those who received EPO were younger and more likely to have congenital heart disease. The use of EPO is associated with fewer post-VAD blood transfusions. EPO was not independently associated with VAD exchange but remained independently associated with stroke during the VAD hospitalization.

Blood transfusion for children in sub-Saharan Africa: 200 years on

In 1818, James Blundell completed the first successful human blood transfusion. This life-saving medical intervention has revolutionised patient care globally in the past two centuries. Nevertheless, many challenges remain in implementing safe blood transfusion procedures, particularly in sub-Saharan Africa 1 Ala F Allain JP Bates I et al. External financial aid to blood transfusion services in sub-Saharan Africa: a need for reflection. PLoS Med. 2012; 9e1001309 Crossref PubMed Scopus (53) Google Scholar where demand predominantly centres on acute paediatric severe anaemia and haemorrhagic complications of pregnancy and trauma. Severe anaemia, when the haemoglobin concentration drops below 6 g/dL, is very common in children admitted to hospital in sub-Saharan Africa. Infectious diseases, nutritional deficiencies, and sickle cell anaemia are the major underlying causes of anaemia. Outcomes remain unsatisfactory, with high mortality and high hospital readmission rates within 6 months of initial admission. 2 Phiri KS Calis JC Faragher B et al. Long term outcome of severe anaemia in Malawian children. PLoS One. 2008; 3e2903 Crossref PubMed Scopus (75) Google Scholar World Blood Donor Day on June 14, 2023, calls for donors to “Give blood, give plasma, share life, share often”. Not only is this a day to celebrate the charitable contributions of blood donors, it is an important opportunity to raise awareness that every pint of blood donated results in critically important life-sustaining therapy, especially for children in sub-Saharan Africa.

Blood Transfusion in Children Aged 1-59 Months at Aguié District Hospital (Niger)

Introduction: Blood transfusion is a common practice in paediatrics. According to the WHO, in 2022, up to 54% of transfusions in low-income countries were given to children under 5 years of age. The aim of this study was to determine the frequency of transfusion in children aged between 2 and 59 months in the paediatric ward of the Aguié district hospital. Patients and method: This was a retrospective descriptive study from 1 January to 31 December 2022. All children aged 1 to 59 months hospitalised and transfused in the paediatric ward were included. Results: Of 5349 patients hospitalised, 1140 were transfused, i.e. a frequency of 21.31%. Females were predominant (50.70%), and the age group 13-24 months was the most represented (38.72%). The majority of patients were transfused on the first day (89.36%). The indications were dominated by severe anaemia associated with infectious diseases (59%) and nutritional diseases (20.92%). Severe malaria accounted for 99.83%. Red cell concentrate was the blood product used. Transfusion reactions were observed in 4.8% of patients, mainly fever and chills. The majority of patients were transfused in October (31%), with a mortality rate of 2.37%. Conclusion: Blood transfusion is fairly frequent in the paediatric department of the Aguié district hospital. Awareness-raising to prevent malaria and malnutrition would reduce its frequency.

Parent perceptions of emergent blood transfusion in children.

RhD-negative blood products are in chronic short supply leading to renewed interest in utilizing RhD-positive blood products for emergency transfusions. This study assessed parental perceptions of emergency RhD-positive blood use in children. A survey of parents/guardians was conducted on their tolerance of transfusing RhD-positive blood to RhD-negative female children ≤17 years old at four level 1 pediatric hospitals. In total, 621 parents/guardians were approached of whom 378/621 (61%) completed the survey in its entirety and were included in the analysis. Respondents were mostly females [295/378 (78%)], White [242/378 (64%)], had some college education [217/378 (57%)] and less than $60,000 annual income [193/378 (51%)]. Respondents had a total of 547 female children. Most children's ABO [320/547 (59%)] and RhD type [348/547 (64%)] were not known by their parents; of children with known RhD type, 58/186 (31%) were RhD-negative. When the risk of harm to a future fetus was given as 0-6%, more than 80% of respondents indicated that they were likely to accept RhD-positive blood transfusions on behalf of RhD-negative female children in a life-threatening situation. The rate of willingness to accept emergent RhD-incompatible blood transfusions significantly increased as the potential survival benefit of the transfusion increased. Most parents were willing to accept RhD-positive blood products on behalf of RhD-negative female children in an emergency situation. Further discussions and evidence-based guidelines on transfusing RhD-positive blood products to RhD-unknown females in emergency settings are needed.

Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial

IntroductionDiarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where...

A retrospective study of intraoperative blood transfusion in children with congenital heart disease

A retrospective study of intraoperative blood transfusion in children with congenital heart disease

Наиболее значимые постнатальные факторы, влияющие на течение различных форм ретинопатии недоношенных

Purpose.To evaluate the most significant factors affecting the course of ROP. Material and methods. From 2009 to 2018, we examined 4120 children with ROP. The examination of children was carried out as part of a neonatal screening to detect ROP using standard diagnostic methods. Results. Against the background of prolonged oxygen therapy in children with broncho-pulmonary dysplasia (BPD), severe forms of ROP developed in 9.7% of cases, which is significantly lower than similar indicators in the pathology departments of premature and newborns. Among children with severe apnea, the onset of different-sized hemorrhages, mainly preretinal located in various parts of the fundus, mostly at the ends of the vascular arcades is observed in 70.4% of cases. In 25.9% of children with severe ROP, partial hemophthalmus appears. During blood transfusions in children with severe forms of ROP, the transition of the disease to a more severe stage was reduced in 64.0%, caliber and tortuosity of the retinal vessels increased in 79.8%, retinal edema and exudative manifestations intensified in 39,3%, hemorrhagic changes rose in 49,4%, extraretinal proliferation increased in 50.6%. Against the background of adenoviral epidemic keratoconjunctivitis (AEK) in children with severe forms of ROP, the exudation in the vitreous body sharply increased in 34.7%, retinal detachment developed in 4.1% of cases, even though the children had already undergone laser coagulation of the retina at the time of infection, fresh hemorrhages mainly at the ends of the vascular arcades appeared in 57.1%. Conclusions. Prolonged oxygen therapy under BPD reduces the severity of the ROP. The impact of blood transfusions is observed only in severe forms of ROP. Frequent episodes of apnea contribute to the development of intraocular hemorrhages during ROP. The course of adenoviral AEK exacerbates the course of severe forms of ROP. Key words: retinopathy of prematurity, blood transfusion, apnea, broncho-pulmonary dysplasia, adenoviral epidemic keratoconjunctivitis, risk factors of retinopathy of prematurity

80 To Transfuse or Not to Transfuse: Choosing blood transfusions wisely in young children hospitalized with iron deficiency anemia

Abstract Background Nutritional iron deficiency anemia (IDA) peaks in prevalence at 6to 36 months of age. Children with severe IDA often present to emergency departments and may be hospitalized. Currently, little is known about the management and use of packed red blood cell transfusion in hospitalized children with severe IDA. The current Canadian Paediatric Society (CPS) Practice Point on iron requirements in the first 2 years of life (February 2021) provides guidance on prevention of iron deficiency and iron therapy; however, there is no guidance on the use of blood transfusion in children with severe IDA. Choosing Wisely Canada provides guidance on blood transfusions for adults; however, there are no recommendations on transfusion in children. In contrast, the joint American Society of Hematology and American Society of Pediatric Hematology/Oncology Choosing Wisely Task Force recently published (January 2022) recommendations, including avoiding packed red blood cell transfusion for asymptomatic children with IDA and no active bleeding. Objectives To describe the rate of blood transfusion and characteristics of young children hospitalized with IDA. Design/Methods Data from children, 6 to 36 months, hospitalized with IDA (2001-2020) was abstracted from health records using a standardized data collection form. Eligibility criteria were discharge diagnosis of IDA according to International Classification of Diseases codes, and laboratory evidence of IDA (hemoglobin < 110 g/L and at least two abnormal markers such as MCV, ferritin, transferrin, iron). Descriptive statistics were used. Results Of 79 children hospitalized with nutritional IDA (mean age 18.5 months), 34 (43%) received a blood transfusion. Of those receiving a transfusion, the initial mean hemoglobin was 32g/L (range 17-56g/L). Volume of blood given was: 5mL/kg (n=23, 68%), 10mL/kg (n=8, 23%), and >10mL/kg (n=3, 9%). Two children experienced adverse reactions: allergic reaction; non-hemolytic transfusion reaction. Characteristics of the entire cohort (n=79) were: female (n=51, 65%); previously healthy (n=69, 87%); received iron therapy prior to hospitalization (n=6, 8%); tachycardia on presentation (n=47, 59%); daily milk intake (mean 1638mL, range 236-9000mL). Initial laboratory results (mean) were: hemoglobin 40g/L (range 15-85g/L); MCV 51fL; platelet count 574x109/L; ferritin 3ug/L. Management included dietitian consultation with recommendation to reduce milk intake (n=69, 87%) and all patients received oral iron therapy on discharge (n=79, 100%). No child received intravenous iron therapy during their admission. Conclusion Our findings suggest high rates of blood transfusion among young children hospitalized with iron deficiency anemia. Future research includes examining factors associated with transfusion and practices at other Canadian centres. Our overall aim is to help inform future CPS and Choosing Wisely Canada recommendations.

Comparison of transfusion reactions in children and adults: A systematic review and meta-analysis.

There are no international standards or normalizations for diagnosing and treating complications from blood transfusions. We comprehensively compared the incidence of adverse blood transfusions in children and adults. Available literature on blood transfusion adverse reactions in children and adults prior to November 27, 2021 was collected from several electronic databases. This meta-analysis was performed using Revman 5.2 and Stata 15.1. The incidence of transfusion reactions is higher in children than in adults. Children transfused with red blood cells and platelets exhibited a higher incidence of transfusion reaction than that of adults. Moreover, the incidence of allergic and febrile non-hemolytic transfusion reactions was significantly higher in children than in adults. The incidence of some rare transfusion reactions was also significantly higher in children than in adults. The incidence of transfusion reactions in children and adults is varied. Guidelines for children are necessary.

Anaemia and blood transfusions in children with sickle cell disease of central India

Anaemia and blood transfusions in children with sickle cell disease of central India

Safety of Venous Thromboprophylaxis With Low-molecular-weight Heparin in Children With Ulcerative Colitis.

To evaluate for increased rectal bleeding following enoxaparin thromboprophylaxis in children hospitalized for ulcerative colitis (UC). Retrospective cohort study (2007--2016) of 218 inpatients with active UC. Patients receiving enoxaparin were compared with a nonenoxaparin-treated patient group. Severity of UC was determined using the Pediatric Ulcerative Colitis Activity Index (PUCAI). Hemoglobin (Hb) values and packed red blood cell (pRBC) transfusions were reviewed for a 7-day period following hospital admission. A linear mixed effect model was used to compare change in Hb values between the groups. Risk of pRBC transfusion was compared using a log-rank test and Cox proportional hazard regression. A sub-analysis was also conducted restricting to patients with severe UC to provide more generalizable insight into safety profile of enoxaparin. Children hospitalized for UC and receiving enoxaparin were more likely to have severe disease, received infliximab therapy and be admitted after 2010. Use of enoxaparin showed there was not a difference (P = 0.60) in the fall of Hb detected among those with acute severe colitis (initial PUCAI ≥65) during the week following admission. Moreover, there was no difference in the risk of requiring a pRBC transfusion with enoxaparin use (log-rank test all patients: P = 0.80; severe UC: P = 0.88; Cox proportional hazard regression all patients: P = 0.72; severe UC: 0.85). There was no difference in Hb levels or need for blood transfusions in children hospitalized for severe UC (PUCAI ≥65) whether or not they received enoxaparin for thromboembolism prophylaxis.

Detection of Irregular Antibodies after Blood Transfusion for Children with Thalassemia in Hainan

To investigate the irregular antibody positive rate and antibody specificity in children with thalassemia received long-term blood transfusion in Hainan area and analyze the causes of antibody screening positive. Micro-column gel method was used to screen the irregular antibody in 49 children who received transfusion treatment in our hospital, and the antibody specificity of the positive samples was evaluated. Fourteen of 49 cases showed positive for screening. Among them, 11 cases showed Rh blood group antibody after detecting antibody specificity, 1 case showed the coexistence of irregular antibody and autoantibody. One case for anti-JKa and 1 case for anti-JKb. The positive rate of antibody screening was 16.1% (5/31) in males and 50.0% (9/18) in females. The positive rate of antibody screening was higher in females than that in males. The positive rate of antibody screening in Han and Li nationality was 18.4% (7/38) and 63.6% (7/11), respectively. The positive rate of antibody screening in Li nationality was higher than that in Han nationality. After starting blood transfusion treatment, there were 3 cases (15.8%) of antibody screening positive at birth to 6 months old, Three cases (20.0%) of antibody screening positive at 6 months to 1 year old and 8 cases (53.3%) of antibody screening positive at over 1 year old. Three cases with α-thalassemia were negative after screening. Four cases (14.8%) with β-thalassemia were positive after screening. Nine cases (60.0%) with αβ thalassemia were positive after screening, 1 case (25.0%) with undefined type of thalassemia was positive after screening. The positive rate of antibody screening after blood transfusion was highest in children with αβ mixed type of thalassemia. Above-mentimed differences were statistically significant (P<0.05). But there was no significant difference between the positive rate of screening by ABO blood group (P>0.05). Most of the antibodies produced after long-term blood transfusion in the children with thalassemia belong to Rh blood group antibodies; the children with mixed thalassemia are more likely to produce antibodies; the antibody screening positive rate of Li nationality is higher than that of Han nationality, which may be caused by the genetic difference of blood type between Li nationality and Han nationality.

Blood Transfusion: Prevalence, Indications and Associated Factors in Children Presenting to a Tertiary Health Institution in Southeast Nigeria

Blood is an essential component of paediatric care worldwide. Blood and blood products are scarce and expensive and may be associated with health hazards post-transfusion. This study aims at determining the prevalence, indications and associated factors of blood transfusion in children in an academic hospital. Materials and Methods: This was a retrospectively review of all records of blood transfusions conducted at the Children’s Emergency and Paediatrics wards of the State University Teaching Hospital, Southeast Nigeria; from 1^st January 2016 to 31^st December 2017. Results: The prevalence of blood transfusion was 7%. Total number of transfusions was 56. Male: female ratio was 0.8: 1. Median age of transfused children was 5 years (range 2 months to 12 years). Forty one (73.3%) of the transfused children were aged <3 years with 17 (30.4%) being less than 1 year. The most frequent indications for transfusion were severe malaria 36 (64.3%) and sepsis 12 (21.4%). Sedimented red blood cells, 50 (89.3%), was the most frequently transfused blood product while whole blood constituted 11.7%. Case fatality among the transfused children was 16%. Discussion: Blood transfusion rate of 7% is higher than most previous studies, with the most frequent indication being severe malaria. Sedimented red blood cells was the most frequently transfused blood product. Application of malaria control measures is still needed.

Evaluation of Oxidative Stress and Antioxidant Status in Beta Thalassemia Major Patients: A Single-Center Study

Abstract Background: Regular blood transfusion in children with beta thalassemia major lead toperoxidative tissue injury secondary to iron overload, increased oxidative stress and disturbance of oxidant anti-oxidantstatus of patients. Aim of Study: The present study aimed to assessoxidative stress, trace elements and oxidant-antioxidants status of beta thalassemia-major (b-TM) patients on regular blood trans-fusion. Patients and Methods: A case-control study included 35 beta thalassemic patients attending the pediatric Haematolo-gyclinic of El-Galaa Teaching Hospital and 35 age sex healthy matched subjects as control group. Serumzinc (Zn), copper (Cu), magnesium (Mg), serum Malondialdehyde (MDA), Superoxide Dismutase (SOD), serum catalase (CAT), Total Antioxidant Capacity (TAC) were performed for both patients and control. Results: Meanserum iron, ferritin, Alanine Transaminase (ALT), Aspartate Transaminase (AST) and total bilirubin levels were significantly higher in the b-TM group while mean hemoglobin, hematocritand total iron binding capacity were lower in the b-TM group. A significant increase in the levels of MDA, SOD whereas significant decrease in the levels of serum Zn, Mg. TAC and CAT was observed in the b-TM group. No significant difference in serum Cu between patients and control. Serum ferritin was found to have positive correlation with patients' age, weight, height, ALT, AST and total bilirubin, MDA, serum iron while significant negative correlation with total iron binding capacity, serum Zn and Mg levels whereas no significant correlation with serum Cu, SOD, CAT, TAC. Conclusion: Childrenwith beta thalassemia major suffering from oxidative stress, deficiency of some micronutrients and endogenous antioxidants. Selected trace elements and antioxi-dants supplementation require further studies for their eva-luation.

Post-malarial anemia in Mozambican children treated with quinine or artesunate: A retrospective observational study

ObjectivesThis retrospective analysis performed in Manhiça, Southern Mozambique, aimed to describe the frequency of post-malarial anemia (measured as a decrease of hematocrit ≥10%) and the need for blood transfusions in children with severe malaria treated with intravenous quinine or parenteral artesunate. MethodsAll children <15 years admitted with a parasitologically-confirmed diagnosis of malaria from 1st January 2003 to 31st December 2017, alive at hospital discharge, and with at least one measurement of hematocrit within 28 days after hospital discharge, detected by passive case detection, were included. ResultsThe overall prevalence of post-malarial anemia observed in the study was 23.13%, with an estimated incidence rate of 288.84 episodes/1,000 children-month at risk in the follow-up period (28 days after discharge). There were no differences between treatment groups, although the study showed a higher association between blood transfusions and artesunate treatment. ConclusionsIn this setting, children with severe malaria frequently present a meaningful decrease of hematocrit (>=10%) in the first weeks after their episode, sometimes requiring blood transfusions. Because of the high underlying prevalence of anemia in malaria-endemic settings, all children with severe malaria need to be actively followed up, irrespective of the treatment received.

4148 Thrombocytopenia and whole blood transfusion in children with severe falciparum malaria

OBJECTIVES/GOALS: Severe malarial anemia due to Plasmodium falciparum is often accompanied by thrombocytopenia. Treatment includes transfusion of whole blood, which contains erythrocytes, platelets, and other blood components. The objective of the study was to assess the effect of whole blood transfusion on survival in children with severe falciparum malaria and to examine the potential interaction of thrombocytopenia with malaria mortality and transfusion response. METHODS/STUDY POPULATION: We analyzed a retrospective cohort of 842 hospitalized children in Zambia with severe malarial anemia (703 transfused, 139 not transfused due to stock-out or other reason). Severe malarial anemia was defined as a positive rapid diagnostic test or blood smear in combination with an admission hemoglobin concentration ≤5 g/dL. RESULTS/ANTICIPATED RESULTS: Mortality was 13% (94/703) in the transfused group and 24% (34/139) in the non-transfused group. Kaplan-Meier survival estimates stratified by transfusion status and thrombocytopenia (150,000/μL threshold) showed increased mortality in children with thrombocytopenia who did not undergo transfusion, with no differences in mortality among the other transfused and non-transfused groups (log-rank test P = 0.0001). Effect modification analysis by Cox proportional hazards regression adjusted for age, sex, hemoglobin concentration, blood group type, and eosinophilia showed a significant interaction between platelet count and transfusion status (P = 0.028). Children with thrombocytopenia who were transfused and died had little or no post-transfusion increase in platelets, in contrast to those who survived. Freshness of transfused whole blood, construed from expiration dates, correlated with greater platelet recovery and improved survival. DISCUSSION/SIGNIFICANCE OF IMPACT: The role of platelets in malaria pathophysiology is complex and incompletely understood; prior studies describe preferential binding of platelets to parasitized erythrocytes and direct parasitocidal activity, whereas others detailed deleterious effects in malaria involving the central nervous system vasculature. These findings point to a potential clinical role for platelet-directed transfusion strategies to improve survival in children with severe falciparum malaria, which should be further assessed in randomized interventional studies.

Transfusions in Children’s Surgery: Characterization and Development of a Model for Benchmarking

BackgroundPerioperative blood transfusions in children are associated with patient morbidity and are often overutilized. In this study, we identify procedures most commonly associated with the use of red blood cells (RBC) in childrens surgery and develop risk-adjusted models for benchmarking. MethodsData from the 2012-2015 National Surgical Quality Improvement Program-Pediatric participant use data files were used. CPT (Current Procedural Terminology) codes were grouped to identify the procedures where transfusions were allocated and associated patient demographics and comorbidities. Patients were stratified in two age groups (0-3 mo and 3 mo to 18 y), and a logistic regression model was developed for each age group. ResultsOf 369,176 total cases, 21,410 (5.8%) were associated with a perioperative transfusion. 659 CPT codes were grouped in 207 clusters according to their similarities. The most common procedures associated with transfusion were arthrodesis for spinal deformity (n = 9533, 44.5%), followed by craniectomy for craniosynostosis (n = 1853, 8.7%). The logistic regression model for patients <3 mo included 18 variables and had excellent discriminatory performance (area under the curve 0.866). The model for patients ≥3 mo to 18 y had 21 variables and an area under the curve of 0.911. ConclusionsThe majority of transfusions used in children’s surgery are concentrated within a relatively few procedural groups. These findings can help centers in focusing blood optimization efforts on common surgeries with high transfusion rates. In addition, multiple preoperative factors have been built into a risk-adjusted model that can be used for benchmarking blood transfusions among hospitals.

Blood transfusion in children at a university hospital in a middle-income country: The need to reinforce adherence to current guidelines.

Blood component transfusion is a common procedure used during hospital admissions; however, it is not risk-free. The evaluation of correct use of blood products (BP) is of vast importance considering the risks and costs implied in their use. Our principal objective was to evaluate the adherence to national guidelines for blood transfusion in pediatric patients at a third level university hospital. A prospective and retrospective descriptive analytical study was conducted to report the incidence of incorrect use of BP in pediatric patients (1 month to 16 years of age). In a timeline period of 4 years, 579 medical records were randomly selected from a total of 6575 transfusions realized to create a statistically significant sample. The variables studied were volume, infusion time, and transfusion criteria. Indications were evaluated in patient's medical records according to national guidelines. Of the transfusions analyzed, 54% were classified as incorrect mainly due to lack of transfusion criteria fulfillment. Blood transfusion indications in pediatric patients adhered poorly to national guidelines. The implementation of effective programs for education and information on the use of BP are needed to increase compliance with current guidelines.

Effects of changes in adult erythropoietin dosing guidelines on erythropoietin dosing practices, anemia, and blood transfusion in children on hemodialysis: findings from North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS).

While adult hemodialysis (HD) patients have increased morbidity with higher target hemoglobin levels, similar findings have not been demonstrated in pediatric patients. We evaluated changes in transfusions, anemia frequency, and erythropoietin (epo) dosing among pediatric HD patients before, during, and after implementation of federal dialysis payment policies regarding epo dosing for adult HD patients. This is a retrospective cohort study of pediatric HD patients enrolled in NAPRTCS. We evaluated need for transfusion, anemia, median hemoglobin, and median epo dose 6 months after starting HD in 3 eras: baseline (2003-2007), implementation (2008-2011), and post implementation (2012-2016). We used multivariate logistic regression models to evaluate potential differences in transfusion across the eras. Six months after dialysis initiation, 12.6% of patients required transfusion pre-implementation, 17.9% during implementation, and 15.5% post implementation. Anemia occurred in 17.4% of patients pre, 23.5% during, and 23.8% post implementation, with median hemoglobin levels of 11.9 g/dL pre, 11 g/dL during, and 11 g/dL post implementation. Epo use was high across all 3 eras, but epo dosing decreased during and post implementation, despite more anemia during these periods. Odds of transfusion in implementation era compared with pre-implementation was 1.75 (95% CI 1.11-2.77) and odds of transfusion in post implementation era compared with pre was 1.19 (95% CI 0.71-1.98), controlling for age, race, gender, and prior transplant status. During and following implementation of adult epo dosing guidelines, transfusion and anemia frequency increased in pediatric HD patients. Ideal target hemoglobin levels for pediatric dialysis patients warrant further study.