How do we transfuse children in Italy? Results of a national survey

Abstract

Background: Adherence to optimal practices in the preparation and issuance of pediatric blood components can significantly influence patient care outcomes. This study aims to examine the blood banking procedures across prominent Italian children's hospitals, with the goal of identifying both consistent and potentially divergent standards within this field.

Materials and methods: A survey was conducted among the blood banks affiliated with the Italian Association of Pediatric Hospitals. Modeled after the AABB Neonatal and Pediatric Blood Bank Practices Survey, the questionnaire comprised 25 questions covering hospital characteristics, definitions of the neonatal period, pre-transfusion tests, blood component availability, and irradiation protocols.

Results: Fourteen out of the sixteen invited blood banks participated in the survey. The findings revealed a wide range of practices among the surveyed hospitals. Major differences were noted in the neonatal period definition, pre-transfusion compatibility procedures, and platelet transfusion protocols. All hospitals provided leukodepleted packed red blood cells (pRBCs), with differences in availability of autologous blood and reconstituted whole blood. Irradiated blood components were universally accessible, with differences in post-irradiation acceptable storage time. Additionally, differences in dosages for packed red blood cells (pRBCs) and platelet concentrates (PCs) were observed across hospitals.

Conclusions: Standardized guidelines for pediatric transfusion practices within Italian blood banks are of paramount importance. The observed variability underscores the necessity for sharing best practices among centers supplying blood components to pediatric patients.

Figure 1

Hospital characteristics: description of the characteristics of the Hospitals involved in the survey Of the 14 hospitals, 11 (78.6%) are exclusively dedicated to neonatal and pediatric care, all 14 (100%) have Neonatal Intensive Care Units (NICU), 11 hospitals (78.6%) have Oncohematology and Hematopoietic Stem Cell Transplantation (HSCT) Departments, 8 hospitals (57.1%) serve as Trauma-Center hubs, and 10 hospitals (71.4%) provide Extracorporeal Membrane Oxygenation (ECMO) services.

Figure 2

Definition of the neonatal period Description of the definition of the neonatal period: “within 28 days from birth” (<28 days) vs “between 28 days and 4 months from birth” (28 days-4 months) vs “within 4 months from birth” (<4 months).

Figure 3

RBC pre-transfusion tests Representation of transfusion policy in relation to red blood cells (RBC). Use of electronic cross-match (Type and Screen [T&S]) and Coombs

Figure 4

PCs transfusion Representation of the transfusion policy for platelet concentrates (PCs) in relation to ABO compatibility and RhD-negative recipients.

Figure 5

CMV-infection prevention strategies Representation of strategies aimed at preventing CMV infection transmission.