Rationale and Comments
Laboratory studies may not accurately portray the individual’s hemostatic status, bleeding risk, or need for transfusion; laboratory studies must be assessed in the context of the patient’s overall clinical status. Additional platelet function and viscoelastic testing should be performed to guide blood product transfusions in children with (or at risk for) moderate to severe bleeding. Pharmacologic modalities (i.e., antifibrinolytics, topical hemostatic agents) should be utilized as appropriate. Hemoglobin levels should be assessed in the context of the patient’s fluid status, hemodynamics, and degree of cardiopulmonary reserve, with the goal of restrictive RBC transfusion practices.
- Society for the Advancement of Patient Blood Management: Pediatric and Neonatal Medicine
- Carson JL, Guyatt G, Heddle NM, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA. 2016;316(19):2025-2035.
- American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology. 2015;122(2):241-75.
- New HV, Berryman J, Bolton-Maggs PH, et al.; British Committee for Standards in Haematology. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol. 2016;175(5):784-828.
- Valentine SL, Bembea MM, Muszynski JA, et al.; 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. Consensus recommendations for RBC transfusion practice in critically ill children from the pediatric critical care transfusion and anemia expertise initiative. Pediatr Crit Care Med. 2018;19(9):884-898.