Review of the literature on allogeneic red blood cell and plasma transfusions in children

• Published in: Canadian Medical Association journal (CMAJ) 1997-06, Vol.156 (11), p.Insert
• Main Authors: Hume, Heather A, Kronick, Jonathan B, Blanchette, Victor S
• Format: Article
• Language: English
• Subjects: Blood donation & transfusion; Children & youth; Health care; Literature reviews; Systematic review
• ISSN: 0820-3946; 1488-2329

Abstract Objective: To review the published research on allogeneic red blood cell (RBC) and plasma transfusions in children over 4 months of age. Evidence: Search of MEDLINE database between January 1966 and July 1996 and manual search of relevant textbooks. Articles addressing guidelines for administration, evaluation of appropriateness of therapy, utilization and indications for transfusion were selected for review. Results: Most publications containing guidelines for RBC and plasma transfusions do not cover pediatric patients. We identified 18 articles that addressed blood utilization or appropriateness of RBC or plasma transfusions in children; only 6 were randomized or controlled trials. These, as well as observational studies are reviewed. Conclusion: There is a paucity of controlled data on which to base transfusion decisions for pediatric patients. A review of existing recommendations and guidelines was carried out to assist in the development of guidelines for the transfusion of red blood cells (RBCs) and plasma.(f.1,2) It revealed that published reports primarily address blood transfusion in adults. Therefore, a further review was performed to identify evidence-based reports on allogeneic RBC and plasma transfusions in children. These formed the basis for the development of guidelines for RBC and plasma transfusions in children. Methods General systematic review The literature search began with the results of the search and selection process carried out for the development of guidelines for RBC and plasma transfusions in adults.(f.1,2) Those citations were reviewed by 1 of the authors to determine if they were applicable to pediatric transfusions. If this could not be clearly determined from the tide, the abstract was reviewed. This review addresses RBC and plasma transfusions in children over 4 months of age. Readers interested in neonatal transfusions are referred to recent reviews and guidelines.(f.3-6) The review does not address autologous blood transfusions, the complications of blood transfusions or transfusions for children requiring long-term support (e.g., patients with thalassemia, sickle-cell anemia or diamond blackfan anemia). Pediatric systematic review An additional search of MEDLINE from January 1966 to July 1996 was constructed using the medical subject headings (MeSHs) erythrocyte transfusion, blood transfusion or blood component transfusion combined with child as keywords and text words in the titles and abstracts of all citati