loading page

Transfusion Practices for Pediatric Oncology and Hematopoietic Stem Cell Transplantation Patients: Data from the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III (REDS-III)
  • +12
  • Ruchika Goel,
  • Marianne Nellis,
  • Oliver Karam,
  • Sheila Hanson,
  • Christopher Tormey,
  • Ravi Patel,
  • Rebecca Birch,
  • Bruce Sachais,
  • Martha Sola-visner,
  • Ronald Houser,
  • Naomi Luban,
  • Jerome Gottschall,
  • Cassandra Josephson,
  • Jeanne Hendrickson,
  • Matthew Karafin
Ruchika Goel
Johns Hopkins
Author Profile
Marianne Nellis
Weill Cornell Medicine
Author Profile
Oliver Karam
Virginia Commonwealth University
Author Profile
Sheila Hanson
Children's Hospital of Wisconsin
Author Profile
Christopher Tormey
Yale University School of Medicine
Author Profile
Ravi Patel
Emory University School of Medicine
Author Profile
Rebecca Birch
Westat
Author Profile
Bruce Sachais
New York Blood Center
Author Profile
Martha Sola-visner
Boston Children's Hospital
Author Profile
Ronald Houser
Yale University School of Medicine
Author Profile
Naomi Luban
George Washington University School of Medicine and Health Sciences
Author Profile
Jerome Gottschall
Versiti Blood Research Institute Milwaukee
Author Profile
Cassandra Josephson
Emory University School of Medicine
Author Profile
Jeanne Hendrickson
Yale University School of Medicine
Author Profile
Matthew Karafin
University of North Carolina System
Author Profile

Abstract

Purpose: To evaluate transfusion practices in pediatric oncology and hematopoietic stem cell transplant (HSCT) patients. Methods: This is a multicenter retrospective study of children with oncologic diagnoses treated from 2013-2016 at hospitals that participated in the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). Transfusion practices were evaluated by diagnosis code and pre-transfusion laboratory values. Results: A total of 4766 inpatient encounters of oncology and HSCT patients were evaluated, with 39.3% (95% CI 37.9-40.7%) involving a transfusion. Red blood cells (RBCs) were the most commonly transfused component (32.4%; 95% CI 31.1-33.8%), followed by platelets (22.7%; 95% CI 21.5-23.9%). Patients in the 1 to <6-year old age range were most likely to be transfused and HSCT, acute myelogenous leukemia, and aplastic anemia were the diagnoses most often associated with transfusion. The median hemoglobin (Hb) prior to RBC transfusion was 7.5 g/dL (10-90th percentile: 6.4-8.8 g/dL), with 45.7% of transfusions being given at 7-<8 g/dL. The median platelet count prior to platelet transfusion was 20x109/L (10-90th percentile: 8-51x109/L), and 37.9% of transfusions were given at platelet count of >20-50x109/L. The median international normalized ratio (INR) prior to plasma transfusion was 1.7 (10-90th percentile: 1.3-2.7), and 36.3% of plasma transfusions were given at an INR between >1.4-1.7. Conclusion: Transfusion of blood components is common in hospitalized children with cancer. Relatively high pre-transfusion Hb and platelet values and relatively low INR values prior to transfusion across the studied diagnoses highlight the need for evidence- based practice in this population.