PO-03. Specific characteristics of donor blood transfusions in pediatrics

Summary

Transfusions of blood components are an integral part of therapy for in pediatric patients with cancer and hematological conditions. Diagnosis, therapy type, previous treatment, performance status, hematopoietic stem cell transplantation type, and presence of AB0-incompatibility between donor and recipient etc. are among factors affecting transfusion therapy strategy. As overall number of blood transfusions is high, the medical personnel is tasked with providing each pediatric patient treated within bone marrow transplant clinic with an individual and safe approach to transfusions. This study aims to research the specific characteristics of pediatric blood transfusions in transplant clinical as well as at educating the nurses.

Materials and methods

Between 2018 and 2020 a total of 2104 pediatric patients with acute leukemia, malignant neoplasms, non-malignant hematological diseases, and inherited conditions were treated in RM Gorbacheva Research Institute. A total of 489 hematopoietic stem cell transplants (HSCTs) were performed with 327 of them being allogeneic and 162 being autologous. All patients received a total of 7898 of platelet concentrate (PC) transfusion during the study period, among them 2765 whole blood derived PC units, and 4647 apheresis PC units. PC transfusions (with maximum PC dose being 10 ml/kg/hour) were given if platelet count fell below 20*109 in presence of bleeding. Also, a total of 4417 red blood cell (RBC) units from matched donors were administered, 98.7% of patients received irradiated and leukoreduced red blood cells suspension. In 3754 (85%) cases transfusion were given as replacement in patients with mild to moderate (Hb counts of 70-80 g/l) clinically significant anemia. In this case the dose of 5, 7 or 10 ml/kg given art 2-5 ml/kg/hour was administered. In 663 (15%) cases transfusion were performed in patients with bleeding. In these cases the volume of RBC transfused depended on blood loss. All patients were monitored for blood pressure, heart rate, respiratory rate, body temperature, and diuresis before, during and after (within 2 hours) each transfusion with values obtained being recorded into patient’s sheet.

Results

No complications were observed during PC transfusions and 16 adverse events (ranging from urticaria to angioedema) were recorded after their completion and were treated by a physician with antihistamines and/or 1 mg/kg of intravenous methylprednisolone. No complications were observed during RBC transfusions with only one case of urticaria registered afterwards. All transfusions to patients weighing less than 30 kg were performed using Infusomat Space Line Transfusion BBraun systems. This allowed tuning to each patient’s individual characteristics appropriately changing transfusion volume and rate in order to avoid the volume overload, which may have disastrous consequences in children.

Conclusions

Individual approach blood components transfusion adopted to child’s characteristics and transfusion indications significantly reduces the post-transfusion complications risk. The properly trained team of nurses is required in order to provide safe transfusions and quality care to pediatric patients in bone marrow transplant clinic.

Keywords

Blood transfusion, red blood cell suspension, fresh frozen plasma, cryoprecipitate, donor platelets concentrate.