. 2022 Jan 1;23(1):34-51.

doi: 10.1097/PCC.0000000000002851.

Executive Summary of Recommendations and Expert Consensus for Plasma and Platelet Transfusion Practice in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB)

Marianne E Nellis¹, Oliver Karam², Stacey L Valentine³, Scot T Bateman³, Kenneth E Remy⁴, Jacques Lacroix⁵, Jill M Cholette⁶, Melania M Bembea⁷, Robert T Russell⁸, Marie E Steiner⁹, Susan M Goobie¹⁰, Marisa Tucci⁵, Paul A Stricker¹¹, Simon J Stanworth^{1

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16}, Lani Lieberman^{17

18}, Jennifer A Muszynski¹⁹, David F Bauer²⁰, Katherine Steffen²¹, Daniel Nishijima²², Juan Ibla¹⁰, Sitaram Emani²³, Adam M Vogel²⁴, Thorsten Haas²⁵, Ruchika Goel²⁶, Gemma Crighton²⁷, Diana Delgado²⁸, Michelle Demetres²⁸, Robert I Parker²⁹; 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

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
² Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA.
³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
⁴ Division of Pediatric Critical Care Medicine and Pulmonary/Critical Care Medicine, Departments of Pediatrics and Internal Medicine, Washington University of St. Louis, St. Louis, MO.
⁵ Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
⁶ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, NY.
⁷ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁸ Department of Surgery, University of Alabama Birmingham, Birmingham, AL.
⁹ Department of Pediatrics, University of Minnesota, Minneapolis, MN.
¹⁰ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
¹¹ Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, PA.
¹² NHS Blood and Transplant, Oxford, United Kingdom.
¹³ Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
¹⁴ Radcliffe Department of Medicine and Oxford BRC Haematology Theme, University of Oxford, Oxford, United Kingdom.
¹⁵ Division of Pathology & Laboratory Medicine, Children's National Hospital, Washington, DC.
¹⁶ Department of Pathology & Pediatrics, The George Washington University Health Sciences, Washington, DC.
¹⁷ Department of Clinical Pathology, University Health Network Hospitals, Toronto, ON, Canada.
¹⁸ Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
¹⁹ Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
²⁰ Division of Pediatric Neurosurgery Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX.
²¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA.
²² Department of Emergency Medicine, University of California, Davis School of Medicine, Davis, CA.
²³ Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
²⁴ Division of Pediatric Surgery Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX.
²⁵ Department of Pediatric Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
²⁶ Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD.
²⁷ Department of Haematology, Royal Children's Hospital, Melbourne, VIC, Australia.
²⁸ Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY.
²⁹ Department of Pediatric Hematology/Oncology, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY.

PMID: 34989711
PMCID: PMC8820267
DOI: 10.1097/PCC.0000000000002851

Executive Summary of Recommendations and Expert Consensus for Plasma and Platelet Transfusion Practice in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB)

Marianne E Nellis et al. Pediatr Crit Care Med. 2022.

. 2022 Jan 1;23(1):34-51.

doi: 10.1097/PCC.0000000000002851.

Authors

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
² Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA.
³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
⁴ Division of Pediatric Critical Care Medicine and Pulmonary/Critical Care Medicine, Departments of Pediatrics and Internal Medicine, Washington University of St. Louis, St. Louis, MO.
⁵ Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
⁶ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, NY.
⁷ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁸ Department of Surgery, University of Alabama Birmingham, Birmingham, AL.
⁹ Department of Pediatrics, University of Minnesota, Minneapolis, MN.
¹⁰ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
¹¹ Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, PA.
¹² NHS Blood and Transplant, Oxford, United Kingdom.
¹³ Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
¹⁴ Radcliffe Department of Medicine and Oxford BRC Haematology Theme, University of Oxford, Oxford, United Kingdom.
¹⁵ Division of Pathology & Laboratory Medicine, Children's National Hospital, Washington, DC.
¹⁶ Department of Pathology & Pediatrics, The George Washington University Health Sciences, Washington, DC.
¹⁷ Department of Clinical Pathology, University Health Network Hospitals, Toronto, ON, Canada.
¹⁸ Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
¹⁹ Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
²⁰ Division of Pediatric Neurosurgery Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX.
²¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA.
²² Department of Emergency Medicine, University of California, Davis School of Medicine, Davis, CA.
²³ Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
²⁴ Division of Pediatric Surgery Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX.
²⁵ Department of Pediatric Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
²⁶ Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD.
²⁷ Department of Haematology, Royal Children's Hospital, Melbourne, VIC, Australia.
²⁸ Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY.
²⁹ Department of Pediatric Hematology/Oncology, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY.

PMID: 34989711
PMCID: PMC8820267
DOI: 10.1097/PCC.0000000000002851

Abstract

Objectives: Critically ill children frequently receive plasma and platelet transfusions. We sought to determine evidence-based recommendations, and when evidence was insufficient, we developed expert-based consensus statements about decision-making for plasma and platelet transfusions in critically ill pediatric patients.

Design: Systematic review and consensus conference series involving multidisciplinary international experts in hemostasis, and plasma/platelet transfusion in critically ill infants and children (Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding [TAXI-CAB]).

Setting: Not applicable.

Patients: Children admitted to a PICU at risk of bleeding and receipt of plasma and/or platelet transfusions.

Interventions: None.

Measurements and main results: A panel of 29 experts in methodology, transfusion, and implementation science from five countries and nine pediatric subspecialties completed a systematic review and participated in a virtual consensus conference series to develop recommendations. The search included MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020, using a combination of subject heading terms and text words for concepts of plasma and platelet transfusion in critically ill children. Four graded recommendations and 49 consensus expert statements were developed using modified Research and Development/UCLA and Grading of Recommendations, Assessment, Development, and Evaluation methodology. We focused on eight subpopulations of critical illness (1, severe trauma, intracranial hemorrhage, or traumatic brain injury; 2, cardiopulmonary bypass surgery; 3, extracorporeal membrane oxygenation; 4, oncologic diagnosis or hematopoietic stem cell transplantation; 5, acute liver failure or liver transplantation; 6, noncardiac surgery; 7, invasive procedures outside the operating room; 8, sepsis and/or disseminated intravascular coagulation) as well as laboratory assays and selection/processing of plasma and platelet components. In total, we came to consensus on four recommendations, five good practice statements, and 44 consensus-based statements. These results were further developed into consensus-based clinical decision trees for plasma and platelet transfusion in critically ill pediatric patients.

Conclusions: The TAXI-CAB program provides expert-based consensus for pediatric intensivists for the administration of plasma and/or platelet transfusions in critically ill pediatric patients. There is a pressing need for primary research to provide more evidence to guide practitioners.

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Conflict of interest statement

Drs. Nellis, Bateman, Bembea, and Russell received support for article research from the National Institutes of Health. Dr. Bembea’s institution received funding from the National Institute of Neurologic Disorders and Stroke (R01NS106292), the National Institute of Child Health and Human Development, and Grifols Investigator Sponsored Research Grant. Dr. Nishijima received funding from Bristol Myers Squibb. Dr. Emani received funding from Cheisi Pharmaceuticals. Dr. Haas received funding from Octapharma. Dr. Goel received funding from the National Heart, Lung, and Blood Institute and Rigel Pharmaceuticals. Dr. Crighton disclosed that she is employed by Royal Children’s Hospital of Melbourne, Australia and that she was the Australian and New Zealand Society of Blood Transfusion President. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
Clinical Decision Tree to Aid Prescription of Plasma in Critically Ill Children

**Figure 2.**
Clinical Decision Tree to Aid Prescription of Platelets in Critically Ill Children

See this image and copyright information in PMC

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Executive Summary of Recommendations and Expert Consensus for Plasma and Platelet Transfusion Practice in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB)

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Executive Summary of Recommendations and Expert Consensus for Plasma and Platelet Transfusion Practice in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB)

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