Recommendations on RBC Transfusion Support in Children With Hematologic and Oncologic Diagnoses From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
Recommendations on RBC Transfusion Support in Children With Hematologic and Oncologic Diagnoses From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
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儿科重症监护输血和贫血专业知识倡议对患有血液学和肿瘤学诊断的儿童的红细胞输血支持的建议。
DOI：
10.1097/pcc.0000000000001610
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发表时间：
2018-09
期刊：
影响因子：
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通讯作者：
Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
中科院分区：
文献类型：
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作者：
Steiner ME;Zantek ND;Stanworth SJ;Parker RI;Valentine SL;Lehmann LE;Josephson CD;Bateman ST;Luban NLC;Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI);Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
提出儿科重症护理输血和贫血专业倡议 (TAXI) 为患有血液学和肿瘤疾病的危重儿童输注红细胞 (RBC) 的建议和支持证据。危重儿童红细胞输血管理国际多学科专家系列共识会议由 38 名专家组成的专家小组制定了基于证据和缺乏证据时基于专家的危重儿童红细胞输血临床建议和研究重点。血液学/肿瘤学亚组包括七名专家。从 1980 年到 2017 年 5 月，使用 PubMed、EMBASE 和 Cochrane 图书馆 (CENTRAL) 数据库进行了电子检索。使用研究与开发/加州大学洛杉矶分校 (RAND UCLA) 适当性方法获得了协议。使用建议评估、制定和评估分级 (GRADE) 方法对结果进行总结。血液学/肿瘤学亚组提出了 14 项建议（7 项临床，7 项研究）；全部达成>80%的一致性。对于镰状细胞病患者，TAXI 建议：1) 在需要全身麻醉的外科手术之前，进行红细胞输注以达到 10 g/dL 的目标血红蛋白 (Hb) 浓度，而不是 Hb <30%； 2) 如果孩子的病情恶化（根据临床判断），则建议进行换血而不是简单（非交换）输血，否则建议进行简单的非交换红细胞输血。没有足够的证据对镰状细胞病患者、急性中风或肺动脉高压患者在小手术前的输血阈值提出建议。对于患有肿瘤疾病或接受造血干细胞移植 (HSCT) 的患者，建议 Hb 浓度为 7-8 g/dL。由于缺乏证据，需要进行研究来阐明这些患者的适当输血阈值。 TAXI 制定了有关患有镰状细胞病、肿瘤疾病和 HSCT 的危重儿童红细胞输血管理的具体儿科建议，以及帮助指导未来研究重点的建议。
To present the recommendations and supporting evidence for red blood cell (RBC) transfusions in critically ill children with hematologic and oncologic disease from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI). Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children The panel of 38 experts developed evidence-based and when evidence was lacking, expert-based clinical recommendations and research priorities for RBC transfusions in critically ill children. The hematologic/oncologic subgroup included seven experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from 1980 to May 2017. Agreement was obtained using the Research And Development/University of California, Los Angeles (RAND UCLA) appropriateness method. Results were summarized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. The hematologic/oncologic subgroup developed 14 recommendations (7 clinical, 7 research); all achieved >80% agreement. In patients with sickle cell disease, TAXI recommends: 1) RBC transfusion to achieve a target hemoglobin (Hb) concentration of 10 g/dL rather than Hb of <30% prior to surgical procedures requiring general anesthesia; 2) exchange transfusion over simple (non-exchange) transfusion if the child’s condition is deteriorating (based on clinical judgment), otherwise a simple, non-exchange RBC transfusion is recommended. There is insufficient evidence to make recommendations on transfusion thresholds for patients with sickle cell disease prior to minor procedures, with acute stroke or with pulmonary hypertension. For patients with oncologic disease or undergoing hematopoietic stem cell transplant (HSCT), a Hb concentration of 7–8 g/dL is recommended. Due to lack of evidence, research is needed to clarify the appropriate transfusion thresholds in these patients. TAXI developed specific pediatric recommendations regarding RBC transfusion management in critically ill children with sickle cell disease, oncologic disease, and HSCT, and recommendations to help guide future research priorities.