Pediatric Patient Blood Management Programs: Not Just Transfusing Little Adults

Abstract Red blood cell transfusions are a common life-saving intervention for neonates and children with anemia, but transfusion decisions, indications and doses in neonates and children are different from those of adults. Patient blood management (PBM) programs are designed to assist clinicians wi...

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Bibliographic Details
Published in:	Transfusion medicine reviews 2016-10, Vol.30 (4), p.235-241
Main Authors:	Goel, Ruchika, Cushing, Melissa, Tobian, Aaron A.R
Format:	Article
Language:	eng
Subjects:	Adolescent Anemia - therapy Antifibrinolytic Agents - therapeutic use Blood conservation Blood Transfusion - methods Blood Transfusion - standards Child Child, Preschool Children Clinical Trials as Topic Critical Care Erythrocyte Transfusion - standards Hematology - methods Hematology - trends Hematology, Oncology and Palliative Medicine Hemoglobins - analysis Hemorrhage - drug therapy Humans Infant Infant, Newborn Patient blood management Pediatrics Perioperative Care Platelet Transfusion - methods Platelet Transfusion - standards Research Design Transfusion
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Summary:	Abstract Red blood cell transfusions are a common life-saving intervention for neonates and children with anemia, but transfusion decisions, indications and doses in neonates and children are different from those of adults. Patient blood management (PBM) programs are designed to assist clinicians with appropriately transfusing patients. While PBM programs are well-recognized and appreciated in the adult setting, they are quite far from standard-of-care in the pediatric patient population. Adult PBM standards cannot be uniformly applied to children and there currently is significant variation in transfusion practices. Since transfusing unnecessarily can expose children to increased risk without benefit, it is important to design PBM programs to standardize transfusion decisions. This article assesses the key elements necessary for a successful pediatric PBM program and further systematically explores various possible pediatric specific blood conservation strategies, the current available literature supporting them and outlines the gaps in the evidence suggesting need for further/improved research. Pediatric PBM programs are critically important initiatives that not only involve a cooperative effort between pediatric surgery, anesthesia, perfusion, critical care, and transfusion medicine services but also need operational support from administration, clinical leadership, finance and the hospital information technology personnel. These programs also expand the scope for high quality collaborative research. A key component of pediatric PBM programs is monitoring pediatric blood utilization and assessing adherence to transfusion guidelines. Data suggest restrictive transfusion strategies should be employed for neonates and children similar to adults, but further research is needed to assess the best oxygenation requirements, hemoglobin threshold and transfusion strategy for patients with active bleeding, hemodynamic instability, unstable cardiac disease and cyanotic cardiac disease. Peri-operative blood management strategies include minimizing blood draws, restricting transfusions, intraoperative cell salvage, acute normovolemic hemodilution, anti-fibrinolytic agents, and using point of care tests to guide transfusion decisions. However, further research is needed for the use of intravenous iron, erythropoiesis stimulating agents, and possible use of whole blood and pathogen inactivation. There are numerous areas where newly formed collaborations could be utili
ISSN:	0887-7963 1532-9496