. 2018 Sep;19(9):884-898.

doi: 10.1097/PCC.0000000000001613.

Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Stacey L Valentine¹, Melania M Bembea², Jennifer A Muszynski^{3

4}, Jill M Cholette⁵, Allan Doctor⁶, Phillip C Spinella⁶, Marie E Steiner⁷, Marisa Tucci⁸, Nabil E Hassan⁹, Robert I Parker¹⁰, Jacques Lacroix⁸, Andrew Argent¹¹, Jeffrey L Carson¹², Kenneth E Remy⁶, Pierre Demaret¹³, Guillaume Emeriaud⁸, Martin C J Kneyber¹⁴, Nina Guzzetta¹⁵, Mark W Hall^{3

4}, Duncan Macrae¹⁶, Oliver Karam¹⁷, Robert T Russell¹⁸, Paul A Stricker¹⁹, Adam M Vogel²⁰, Robert C Tasker²¹, Alexis F Turgeon²², Steven M Schwartz²³, Ariane Willems²⁴, Cassandra D Josephson²⁵, Naomi L C Luban²⁶, Leslie E Lehmann²⁷, Simon J Stanworth²⁸, Nicole D Zantek²⁹, Timothy E Bunchman¹⁷, Ira M Cheifetz³⁰, James D Fortenberry²⁵, Meghan Delaney³¹, Leo van de Watering³², Karen A Robinson³³, Sara Malone⁶, Katherine M Steffen³⁴, Scot T Bateman¹; Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI); Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Collaborators, Affiliations

Collaborators

Stacey L Valentine, Scot T Bateman, Andrew Argent, Jeffrey L Carson, Jill M Cholette, Allan Doctor, Jacques Lacroix, Kenneth Remy, Pierre Demaret, Guillaume Emeriaud, Nabil E Hassan, Martin C J Kneyber, Marisa Tucci, Nina Guzzetta, Mark W Hall, Jennifer A Muszynski, Philip C Spinella, Duncan Macrae, Oliver Karam, Robert T Russell, Paul Stricker, Adam M Vogel, Robert C Tasker, Alexis F Turgeon, Steven M Schwartz, Ariane Willems, Cassandra D Josephson, Naomi L C Luban, Leslie E Lehmann, Robert I Parker, Simon J Stanworth, Marie E Steiner, Nicole D Zantek, Melania M Bembea, Timothy Bunchman, Ira M Cheifetz, James D Fortenberry, Meghan Delaney, Robert I Parker, Leo van de Watering, Karen A Robinson, Sara Malone, Katherine Steffen

Affiliations

¹ Division of Pediatric Critical Care, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
² Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
³ Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
⁴ The Research Institute at Nationwide Children's Hospital, Columbus, OH.
⁵ Department of Pediatrics, University of Rochester, Rochester, NY.
⁶ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
⁷ Department of Pediatrics, University of Minnesota, Minneapolis, MN.
⁸ Department of Pediatrics, University of Montreal, Montreal, QC, Canada.
⁹ Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL.
¹⁰ Department of Pediatrics, Stony Brook University, Stony Brook, NY.
¹¹ Department of Pediatrics, University of Cape Town, Cape Town, South Africa.
¹² Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
¹³ Department of Pediatrics, CHC, Liege, Belgium.
¹⁴ Department of Pediatrics, University of Groningen, Groningen, The Netherlands.
¹⁵ Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
¹⁶ Pediatric Critical Care, Royal Brompton Hospital, London, United Kingdom.
¹⁷ Department of Pediatrics, Professor and Director Pediatric Nephrology, Childrens Hospital of Richmond, Virginia Commonwealth University, Richmond, VA.
¹⁸ Department of Surgery, University of Alabama Birmingham, Birmingham, AL.
¹⁹ Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA.
²⁰ Division of Pediatric Surgery and Pediatrics, Baylor College of Medicine, Houston, TX.
²¹ Departments of Neurology and Anesthesia (Pediatrics), Harvard Medical School, Boston, MA.
²² Department of Anesthesiology and Critical Care Medicine, Univesite Laval Research Center, Quebec City, QC, Canada.
²³ Department of Critical Care Medicine and Paediatrics, University of Toronto, ON, Canada.
²⁴ Pediatric Intensive Care Unit, University of Brussels, Brussels, Belgium.
²⁵ Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
²⁶ Department of Pediatrics and Pathology, George Washington University, Washington, DC.
²⁷ Department of Pediatrics, Harvard Medical School, Boston, MA.
²⁸ Department of Medicine, University of Oxford, Oxford, United Kingdom.
²⁹ Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.
³⁰ Department of Pediatrics, Duke University, Durham, NC.
³¹ Division of Pathology and Laboratory Medicine, Children's National Health System, Washington, DC.
³² Sanquin-Leiden University Medical Center, Leiden, The Netherlands.
³³ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
³⁴ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.

PMID: 30180125
PMCID: PMC6126913
DOI: 10.1097/PCC.0000000000001613

Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Stacey L Valentine et al. Pediatr Crit Care Med. 2018 Sep.

. 2018 Sep;19(9):884-898.

doi: 10.1097/PCC.0000000000001613.

Authors

Collaborators

Stacey L Valentine, Scot T Bateman, Andrew Argent, Jeffrey L Carson, Jill M Cholette, Allan Doctor, Jacques Lacroix, Kenneth Remy, Pierre Demaret, Guillaume Emeriaud, Nabil E Hassan, Martin C J Kneyber, Marisa Tucci, Nina Guzzetta, Mark W Hall, Jennifer A Muszynski, Philip C Spinella, Duncan Macrae, Oliver Karam, Robert T Russell, Paul Stricker, Adam M Vogel, Robert C Tasker, Alexis F Turgeon, Steven M Schwartz, Ariane Willems, Cassandra D Josephson, Naomi L C Luban, Leslie E Lehmann, Robert I Parker, Simon J Stanworth, Marie E Steiner, Nicole D Zantek, Melania M Bembea, Timothy Bunchman, Ira M Cheifetz, James D Fortenberry, Meghan Delaney, Robert I Parker, Leo van de Watering, Karen A Robinson, Sara Malone, Katherine Steffen

Affiliations

¹ Division of Pediatric Critical Care, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
² Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
³ Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
⁴ The Research Institute at Nationwide Children's Hospital, Columbus, OH.
⁵ Department of Pediatrics, University of Rochester, Rochester, NY.
⁶ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
⁷ Department of Pediatrics, University of Minnesota, Minneapolis, MN.
⁸ Department of Pediatrics, University of Montreal, Montreal, QC, Canada.
⁹ Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL.
¹⁰ Department of Pediatrics, Stony Brook University, Stony Brook, NY.
¹¹ Department of Pediatrics, University of Cape Town, Cape Town, South Africa.
¹² Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
¹³ Department of Pediatrics, CHC, Liege, Belgium.
¹⁴ Department of Pediatrics, University of Groningen, Groningen, The Netherlands.
¹⁵ Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
¹⁶ Pediatric Critical Care, Royal Brompton Hospital, London, United Kingdom.
¹⁷ Department of Pediatrics, Professor and Director Pediatric Nephrology, Childrens Hospital of Richmond, Virginia Commonwealth University, Richmond, VA.
¹⁸ Department of Surgery, University of Alabama Birmingham, Birmingham, AL.
¹⁹ Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA.
²⁰ Division of Pediatric Surgery and Pediatrics, Baylor College of Medicine, Houston, TX.
²¹ Departments of Neurology and Anesthesia (Pediatrics), Harvard Medical School, Boston, MA.
²² Department of Anesthesiology and Critical Care Medicine, Univesite Laval Research Center, Quebec City, QC, Canada.
²³ Department of Critical Care Medicine and Paediatrics, University of Toronto, ON, Canada.
²⁴ Pediatric Intensive Care Unit, University of Brussels, Brussels, Belgium.
²⁵ Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
²⁶ Department of Pediatrics and Pathology, George Washington University, Washington, DC.
²⁷ Department of Pediatrics, Harvard Medical School, Boston, MA.
²⁸ Department of Medicine, University of Oxford, Oxford, United Kingdom.
²⁹ Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.
³⁰ Department of Pediatrics, Duke University, Durham, NC.
³¹ Division of Pathology and Laboratory Medicine, Children's National Health System, Washington, DC.
³² Sanquin-Leiden University Medical Center, Leiden, The Netherlands.
³³ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
³⁴ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.

PMID: 30180125
PMCID: PMC6126913
DOI: 10.1097/PCC.0000000000001613

Abstract

Objectives: To date, there are no published guidelines to direct RBC transfusion decision-making specifically for critically ill children. We present the recommendations from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.

Design: Consensus conference series of multidisciplinary, international experts in RBC transfusion management of critically ill children.

Setting: Not applicable.

Intervention: None.

Subjects: Children with, or children at risk for, critical illness who receive or are at risk for receiving a RBC transfusion.

Methods: A panel of 38 content and four methodology experts met over the course of 2 years to develop evidence-based, and when evidence lacking, expert consensus-based recommendations regarding decision-making for RBC transfusion management and research priorities for transfusion in critically ill children. The experts focused on nine specific populations of critically ill children: general, respiratory failure, nonhemorrhagic shock, nonlife-threatening bleeding or hemorrhagic shock, acute brain injury, acquired/congenital heart disease, sickle cell/oncology/transplant, extracorporeal membrane oxygenation/ventricular assist/ renal replacement support, and alternative processing. Data to formulate evidence-based and expert consensus recommendations were selected based on searches of PubMed, EMBASE, and Cochrane Library from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method.

Measurements and results: The Transfusion and Anemia Expertise Initiative consensus conference developed and reached consensus on a total of 102 recommendations (57 clinical [20 evidence based, 37 expert consensus], 45 research recommendations). All final recommendations met agreement, defined a priori as greater than 80%. A decision tree to aid clinicians was created based on the clinical recommendations.

Conclusions: The Transfusion and Anemia Expertise Initiative recommendations provide important clinical guidance and applicable tools to avoid unnecessary RBC transfusions. Research recommendations identify areas of focus for future investigation to improve outcomes and safety for RBC transfusion.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: Dr. Zantek has the following disclosures not related to this project: Octapharma, Terumo BCT, Bayer HealthCare (research funding), Endo International PLC, Boston Scientific (financial interest), North American Specialized Coagulation Laboratory Association (executive board). Dr. Josephson has the following disclosures not related to this project: consultant for Biomet Zimmer, Immuncor and Octapharma. The other authors have no relevant disclosures.

Figures

**Figure 1**
Timeline and overview of the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. RAND/UCLA= Research And Development/University of California, Los Angeles

**Figure 2**
TAXI RBC Transfusion Decision Tree for Critically Ill Children RBC: red blood cell, Hb: hemoglobin, PICU: pediatric intensive care unit, PARDS: pediatric acute respiratory distress syndrome, ECMO: extracorporeal membrane oxygenation, VAD: ventricular assist device.

See this image and copyright information in PMC

References

1. Bateman ST, Lacroix J, Boven K, et al. Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med. 2008;178:26–33. - PubMed
1. Carson JL, Duff A, Poses RM, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348:1055–1060. - PubMed
1. Carson JL, Noveck H, Berlin JA, et al. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion. 2002;42:812–818. - PubMed
1. English M, Ahmed M, Ngando C, et al. Blood transfusion for severe anaemia in children in a Kenyan hospital. Lancet. 2002;359:494–495. - PubMed
1. Lackritz EM, Campbell CC, Ruebush TK, et al. Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet. 1992;340:524–528. - PubMed

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Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Collaborators

Affiliations

Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Miscellaneous