Safety of erythrocyte transfusion over a short period in pediatric patients assessed using cardiac deformation imaging

Abstract

Erythrocyte transfusion is a time-consuming process for both health care personnel and patients. This research is aimed at assessing the safety of erythrocyte transfusion over a short period of time in pediatric patients using innovative echocardiographic parameters, such as tissue Doppler imaging and 2D speckle-tracking echocardiography. Twenty pediatric patients with chronic hemolytic anemia were included in the study. Patients with underlying cardiac, renal, or respiratory dysfunction and severe anemia (hemoglobin < 60 g/L) were excluded. The patients were grouped into small cohorts, and erythrocyte transfusion was initiated at 6 ml/kg/h. If tolerated, the rate was progressively increased by 1 ml/kg/h per cohort until reaching 12 ml/kg/h. Symptoms and signs of clinical intolerance and vital signs were evaluated during and following transfusions. Conventional echocardiography, tissue Doppler imaging, and 2D speckle-tracking echocardiography were performed before and after transfusion. No symptoms or signs of clinical intolerance were reported during or after transfusion. Following transfusion, the heart rate decreased significantly (P = 0.018). No significant changes in the systolic or diastolic functions of the right or left ventricles were observed after transfusion. Following transfusion, significant improvements in the ejection times of the left and right ventricles (P = 0.001 and P = 0.007, respectively) were noted. Similarly, the myocardial performance index significantly improved (P = 0.038 and P = 0.046, respectively). Conclusion: This exploratory study addresses the issue of whether erythrocyte transfusion may be administered at up to 12 ml/kg/h in selected stable pediatric patients with chronic anemia without the risk of developing transfusion-associated circulatory overload or affecting cardiac function. In addition to reducing tachycardia, erythrocyte transfusion improves biventricular ejection time and myocardial performance index (Tei-index).

Keywords: Erythrocyte transfusion; Pediatrics; Short time; Speckle tracking; Transfusion-associated circulatory overload.