Red blood cell transfusion in critically ill children: a narrative review
- GK Istaphabous, DS Wheeler, SJ Lisco, A. Shander
- Pediatr Crit Care Med
B lood banking and transfusion medicine (TM) have developed into uniquely specialized areas; scientific discoveries and technical advances over the past 25 years have allowed remarkable changes in these areas and supported progress in patient care. Driven by advances in basic and clinical sciences and requirements for ever more sophisticated transfusion strategies, there is an expanded need for blood, blood components, plasma products and derivatives, recombinant coagulation proteins, hematopoietic progenitor cells, and other cell-based products for regenerative therapies. These complex demands require highly developed educational training programs for practitioners functioning at all levels to provide TM support for patients. One area that has emerged with a distinct identity under the TM umbrella is transfusion support for pediatric patients. Pediatric transfusion medicine (Ped TM) represents one of the largest and most complex areas within the TM discipline. Although no formal definition of Ped TM exists, Hillyer presented a general description that encompassed the production and manufacture, distribution, and use of blood components for transfusion of fetuses, neonates, infants, children, and adolescents. This definition includes plasma derivatives, recombinant proteins, hematopoietic progenitor cells, and other regenerative technologies. Because of unique pediatric medical conditions, a variety of specialized techniques and procedures such as extracorporeal membrane oxygenation, apheresis, and intraoperative salvage applied to these patients is included under the umbrella of Ped TM. The rationale for designating Ped TM as a distinct area within TM arises from several issues. First, and most important, infants and children present a number of distinct characteristics that make transfusion of this group different than adults. The small body size and associated blood volume provide obvious challenges for transfusion support. The physiology of systems (e.g., hematopoietic and immune) and organs (e.g., the liver, kidney, and others) as well as the spectrum of diseases and pathophysiology of disorders varies with age from preterm and term newborns through adolescents. Congenital and inherited conditions, which may be diagnosed in infants and children, further augment the complexity of transfusion support for this age group. Indications for transfusion of blood components are distinct for infants and children. Since extended long-term survival beyond a transfusion event is implicit in pediatric treatment strategies, the impact of adverse events may be longer lasting and more significant than that in adult populations. Infants, children, and adolescents comprise 25% of the US population, but account for more than 200 million outpatient visits and 80 hospitalizations per 1000 children in 2002. Although nearly 29 million units of blood and blood components are transfused each year in the United States, no precise estimates of the number of transfusions provided to infants and children exist. ABBREVIATIONS: Ped TM = pediatric transfusion medicine; PTMAA = Pediatric Transfusion Medicine Academic Awardees; TM = transfusion medicine.