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; Oliver Karam; Simon J Stanworth; Susan M Goobie; Gemma Crighton; Ruchika Goel; Jacques Lacroix; Marianne E Nellis; Robert I Parker; Katherine Steffen; Paul Stricker; Stacey L Valentine; Marie E Steiner; 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

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

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

Authors

Lani Lieberman^{1

2}, Oliver Karam³, Simon J Stanworth⁴, Susan M Goobie⁵, Gemma Crighton⁶, Ruchika Goel^{7

8}, Jacques Lacroix⁹, Marianne E Nellis¹⁰, Robert I Parker¹¹, Katherine Steffen¹², Paul Stricker¹³, Stacey L Valentine¹⁴, Marie E Steiner¹⁵; 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 Department of Clinical Pathology, University Health Network Hospitals; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
² Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
³ Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA.
⁴ NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, Radcliffe Department of Medicine and Oxford BRC Haematology Theme, University of Oxford, Oxford, United Kingdom.
⁵ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁶ Department of Haematology, Royal Children's Hospital, Melbourne, VIC, Australia.
⁷ Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD.
⁸ Simmons Cancer Institute, Division of Hematology Oncology at SIU School of Medicine, Springfield, IL.
⁹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
¹⁰ Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY.
¹¹ Department of Pediatric Hematology/Oncology, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY.
¹² Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA.
¹³ Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
¹⁴ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
¹⁵ Divisions of Hematology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN.

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Anemia* / therapy
Blood Component Transfusion
Child
Critical Care
Critical Illness / therapy
Disseminated Intravascular Coagulation*
Erythrocyte Transfusion
Evidence-Based Medicine / methods
Hemorrhage
Humans
Infant, Newborn
Liver Failure, Acute*
Liver Transplantation*
Neoplasms*
Plasma
Platelet Transfusion
Sepsis* / therapy

Abstract

Publication types

MeSH terms

Grants and funding