Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Everything You Need to Know About Blood

Everything You Need to Know About Blood

Pdf Summary

The document is a comprehensive lecture by Dr. Jennifer A Muszynski on the considerations surrounding red blood cell (RBC), platelet, and plasma transfusions in critically ill children.<br /><br />Key Points:<br /><br />1. **Clinical Scenarios and Transfusion Decision-making:** Two pediatric case scenarios were presented – a 2-year-old with septic shock and another with pneumonia, both with hemoglobin levels of 8.5 g/dL. The discussion revolves around whether to transfuse RBCs, emphasizing that transfusion decisions should consider more than just hemoglobin levels.<br /><br />2. **Rationale for RBC Transfusion:** The primary reason for transfusing RBCs is to increase oxygen delivery, particularly addressing acute blood loss or life-threatening bleeding. However, the necessity of transfusion in non-bleeding patients (anemia management) is questioned.<br /><br />3. **Studies on Transfusion Strategies:** A multicenter trial indicated that a restrictive transfusion strategy (hemoglobin threshold 7 g/dL) in hemodynamically stable critically ill children is as safe as a liberal strategy (threshold 9.5 g/dL). This suggests maintaining higher hemoglobin levels isn’t always beneficial and that hemoglobin alone is a poor determinant of transfusion necessity.<br /><br />4. **Risks Associated with Transfusions:** Various risks are outlined, including acute hemolytic transfusion reactions due to ABO incompatibility, transfusion-associated circulatory overload (TACO), and transfusion-associated acute lung injury (TRALI). These complications highlight that transfusion is not risk-free and should be carefully considered.<br /><br />5. **Recommendations for Transfusions:** Guidelines such as the TAXI RBC transfusion recommendations were discussed, suggesting restrictive transfusion for stable patients with hemoglobin levels above 7 g/dL, indicating that a one-size-fits-all approach is not appropriate.<br /><br />6. **Platelet and Plasma Transfusions:** Transfusions primarily aimed at preventing bleeding in critically ill children were critiqued, with studies suggesting that higher prophylactic thresholds for platelet transfusions may be harmful.<br /><br />7. **Patient Blood Management (PBM):** Key strategies for PBM include allowing permissive anemia when suitable, avoiding unnecessary transfusions, pre-operative planning, early intervention to prevent or treat bleeding, and minimizing laboratory draws.<br /><br />Overall, the document underscores a cautious and individualized approach to transfusions to balance benefits and risks, with a preference for restrictive strategies in many cases.

Keywords

RBC transfusion

platelet transfusion

plasma transfusion

critically ill children

hemoglobin levels

transfusion risks

restrictive strategy

Patient Blood Management

TAXI guidelines

transfusion complications

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