The primary goal of transfusion medicine is to provide the safest blood transfusions possible for patients who need them. In the pediatric patient population, red blood cell (RBC) transfusions comprise the majority of transfusions (58.5%), followed by platelet and plasma transfusions (26% and 15.4%, respectively).1
While pediatric patients received 2.6% of the 15 million red cell units and 2.3% of the 4.5 million plasma units transfused annually, the most recent available National Blood Collection and Utilization Survey reports that there was a 7.6% increase in RBC transfusions in the pediatric population, which is in contrast to the declining trends identified in the adult patient population.1 In addition, the overall trends for platelet transfusions indicate an increase, as well as for other blood derivatives, such as intravenous immunoglobulin (IVIG).
Recognition of the clinical benefits of hemotherapy should help guide the clinician in the decision to transfuse. These benefits must be weighed against adverse events associated with transfusion, including infections, as well as cost. A British report indicated that the most common error (80% of errors) in pediatrics is transfusion of the incorrect blood component.2 In this report, a blood component was considered to be incorrect if it did not meet special requirements, if there was an administrative error, or when there was a laboratory error. Examples included not transfusing a cytomegalovirus (CMV)-negative or irradiated unit when required by hospital policy, transfusing one twin with an RBC unit intended for the other, or not considering maternal anti-erythrocyte antibodies when selecting an RBC unit for a neonate. An understanding of pediatric-specific issues may help minimize such problems.
Transfusional requirements and parameters may differ between children and adults, especially in neonates and young children. Most studies focus on adults with extrapolation of these data and guidelines to children. Children have slightly higher blood volume per kilogram (of ideal body weight) than adults. Term neonates have 85 mL/kg, while preterm neonates have 100 mL/kg. Children up to pre-adolescence have 75 to 85 mL/kg and adolescents have 70 to 75 mL/kg. Neonates are at risk for anemia due to phlebotomy and a poor erythropoietic response. Neonatal organ functions are not fully developed and may lead to metabolic and electrolyte imbalances following transfusion. Small-volume and slow-rate transfusions may prevent such problems. With more rapid transfusions, particular attention should be given to hypocalcemia due to citrate present in blood components as well as hyperkalemia. Neonates, especially premature infants, are also at risk for hypothermia and its attendant problems, such as acidosis and hypoxia.3 The use of blood warmers may be useful for more rapid transfusions in susceptible neonates.
In most instances, medical consent should be obtained from the parents and/or legal guardians of all children requiring blood transfusions.4 Institution-specific policies may also require obtaining assent from certain minors who have some decision-making capacity. The exception is when ...