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)
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.