title: Transfusion in critically ill children: indications, risks, and challenges.
abstract: OBJECTIVE
  To provide a concise review of transfusion-related issues and practices in the pediatric patient population, with a focus on those issues of particular importance to the care of critically ill children.
  
  
  METHODS
  Electronic search of the PubMed database using the search terms "pediatric transfusion," "transfusion practices," "transfusion risks," "packed red blood cell transfusion," "white blood cell transfusion," "platelet transfusion," "plasma transfusion," and "massive transfusion" either singly or in combination.
  
  
  METHODS
  All identified articles published since 2000 were manually reviewed for study design, content, and support for indicated conclusions, and the bibliographies were scrutinized for pertinent references not identified in the PubMed search. Selected studies from this group were then manually reviewed for possible inclusion in this review.
  
  
  RESULTS
  Well-designed studies have demonstrated the benefit of "restrictive" transfusion practices across the entire age spectrum of pediatric patients across a wide spectrum of pediatric illness. However, clinician implementation of the more restrictive transfusion practices supported by these studies is variable. Additionally, the utilization of both platelet and plasma transfusions in either a "prophylactic" or "therapeutic" setting appears to be greater than that supported by published data.
  
  
  CONCLUSIONS
  The preponderance of prospective, randomized trials and retrospective analyses support the use of a restrictive packed RBC transfusion policy in most clinical conditions in children. Neonatal transfusions guidelines rely largely on "expert opinion" rather than experimental data. Current transfusion practices for both platelets and coagulant products (e.g., fresh-frozen plasma and recombinant-activated factor VII) are poorly aligned with recommended transfusion guidelines. As with adults, current transfusion practices in children often do not reflect implementation of our current knowledge on the need for transfusion. Greater efforts to implement current evidence-based transfusion practices are needed.
authors.affiliation: 1Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY. 2Pediatric Hematology/Oncology, Stony Brook Long Island Children's Hospital, Stony Brook, NY.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Parker
mesh_terms: D016913:Blood Component Transfusion / Q000009:adverse effects / Q000592:standards; D001803:Blood Transfusion / Q000401:mortality* / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000592:standards; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects / Q000592:standards; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D065227:Transfusion Reaction; D016896:Treatment Outcome