Transfusion therapy with allogeneic blood components in children of cardiosurgical units

Abstract

The article discusses features of allogeneic blood component transfusion in newborns and infants. This work is primarily addressed to specialists of "non–transfusiological" profile, such as neonatologists, anesthesiologists, intensive care specialists, pediatricians, hematologists and pediatric surgeons. Specific anatomical and physiological structure of child's organism, especially at its neonatologic period, specifies different approaches to the clinical application of donor blood components. However, description of transfusion therapy in children is found only in a small proportion of clinical recommendations, and its legislative level is regulated with an order of the Ministry of Health and the Government decree. Last documents are of administrative nature, and do not help much clinicians in specific decision-making situation. At the same time, transfusion with allogeneic blood is associated with significant complications. The overall prevalence of posttransfusion reactions in children is higher than in adults, and is associated with higher mortality rates. This is especially true for pediatric cardiac surgery. Application of donated blood after cardiopulmonary bypass surgery is associated with postoperative complications such as thrombosis, stroke, acute kidney injury, prolonged mechanical ventilation and death. The authors emphasize the necessity of scientific substantiation of each transfusion with evidence-based medicine. Indications for hemotransfusion have to rely not only on the concentration of hemoglobin and hematocrit, but also on additional physiological triggers. In order to minimize undesirable transfusion reactions and complications, modern technologies should be used to improve the quality of blood components. Attention is focused on modern components of donated blood. The review is aimed to summarize and structure current data on transfusion therapy in pediatric patients. The authors analyse domestic and foreign clinical recommendations and publications. Restrictive and liberal strategies of transfusion therapy are compared. Specific criteria for indications, algorithms for prescription, speed and volume of donor blood component infusion in pediatric units were revealed.

Keywords

neonatology / pediatrics / pediatric cardiac surgery / blood transfusion

References

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