• Pediatr Crit Care Me · Sep 2018

    Practice Guideline

    Recommendations on RBC Transfusion in Critically Ill Children With Acute Brain Injury From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.

    • Robert C Tasker, Alexis F Turgeon, Philip C Spinella, Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI), and Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.
    • Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA.
    • Pediatr Crit Care Me. 2018 Sep 1; 19 (9S Suppl 1): S133S136S133-S136.

    ObjectivesTo present the recommendations and supporting literature for RBC transfusions in critically ill children with acute brain injury developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.DesignConsensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children.MethodsThe panel of 38 experts developed evidence-based, and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The acute brain injury subgroup included three experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method.ResultsTransfusion and Anemia Expertise Initiative Consensus Conference experts developed and agreed upon two clinical and two research recommendations focused on RBC transfusion in the critically ill child with acute brain injury. Recommendations include consideration of RBC transfusion for a hemoglobin concentration between 7 and 10 g/dL in patients with acute brain injury and do not support the use of brain tissue PO2 monitoring to guide RBC transfusion decisions. Research is needed to better understand transfusion thresholds and brain tissue monitoring for pediatric patients with acute brain injury.ConclusionsThe Transfusion and Anemia Expertise Initiative Consensus Conference developed pediatric-specific clinical and research recommendations regarding RBC transfusion in the critically ill child with acute brain injury. Although agreement among experts was very strong, the available pediatric evidence was extremely limited with major gaps in the literature.

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