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. 2022 Jan 1;23(13 Suppl 1 1S):e37-e49.
doi: 10.1097/PCC.0000000000002857.

Plasma and Platelet Transfusion Strategies in Critically Ill Children With Malignancy, Acute Liver Failure and/or Liver Transplantation, or Sepsis: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding

Lani Lieberman  1   2 , Oliver Karam  3 , Simon J Stanworth  4 , Susan M Goobie  5 , Gemma Crighton  6 , Ruchika Goel  7   8 , Jacques Lacroix  9 , Marianne E Nellis  10 , Robert I Parker  11 , Katherine Steffen  12 , Paul Stricker  13 , Stacey L Valentine  14 , Marie E Steiner  15 ; Pediatric Critical Care Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding (TAXI-CAB), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Affiliations

Plasma and Platelet Transfusion Strategies in Critically Ill Children With Malignancy, Acute Liver Failure and/or Liver Transplantation, or Sepsis: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding

Lani Lieberman et al. Pediatr Crit Care Med. .

Abstract

Objectives: To present the consensus statements with supporting literature for plasma and platelet transfusions in critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding.

Design: Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children.

Setting: Not applicable.

Patients: Critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation.

Interventions: None.

Measurements and main results: A panel of 13 experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed 12 expert consensus statements.

Conclusions: In the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding program, the current absence of evidence for use of plasma and/or platelet transfusion in critically ill children with malignancy, acute liver disease and/or following liver transplantation, and sepsis means that only expert consensus statements are possible for these areas of practice.

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Conflict of interest statement

Dr. Crighton disclosed that she is employed by the Royal Children’s Hospital of Melbourne, Australia, and she was the Australian and New Zealand Society of Blood Transfusion President. Dr. Nellis received support for article research from the National Institutes of Health. Dr. Steiner received funding from Pumps for Kids, Infants, and Neonates (PumpKIN) Data Safety and Monitoring Board and HealthCore. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Papers Flow Chart Critically ill children with malignancy
Figure 2.
Figure 2.
Papers Flow Chart for Critically ill children with acute liver failure and/or liver transplantation
Figure 3.
Figure 3.
Papers flow chart for critically ill children with sepsis and/or DIC
See this image and copyright information in PMC

References

    1. Nellis ME, Karam O, Mauer E, et al. Platelet Transfusion Practices in Critically Ill Children. Crit Care Med 2018; 46:1309–1317. - PMC - PubMed
    1. Nellis ME, Goel R, Karam O, et al. International Study of the Epidemiology of Platelet Transfusions in Critically Ill Children With an Underlying Oncologic Diagnosis. Pediatr Crit Care Med 2019; 20:e342–e351. - PubMed
    1. Karam O, Demaret P, Shefler A, et al. Indications and Effects of Plasma Transfusions in Critically Ill Children. Am J Respir Crit Care Med 2015; 191:1395–1402. - PubMed
    1. New HV, Stanworth SJ, Gottstein R, et al. British Society for Haematology Guidelines on transfusion for fetuses, neonates and older children (Br J Haematol. 2016;175:784–828). Addendum August 2020. Br J Haematol 2020;191:725–727. - PubMed
    1. New HV, Berryman J, Bolton-Maggs PH, et al. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol 2016; 175:784–828. - PubMed

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