Society for the Advancement of Patient Blood Management: Pediatric and Neonatal Medicine
View all recommendations from this societySeptember 22, 2021
Avoid dependence on standard laboratory values for transfusion decisions; consideration of the patient’s clinical status is requisite.
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.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The Executive Committee and Board of Directors (BOD) of the Society for the Advancement of Patient Blood Management (SABM) had a strong desire to participate in the Choosing Wisely® campaign. Participation allows SABM to align with the national Choosing Wisely® team and other specialty societies to further the mission of collaborative physician-patient healthcare delivery and responsible use of resources.
A Task Force composed of specialists in neonatal and pediatric medicine and surgery was appointed at the suggestion of the SABM Educational Oversight Committee. With SABM BOD approval, this Task Force drafted an initial set of statements. Evidence-based recommendations were based on our Society’s foundational pillars and structured around published SABM Standards. For this particular list, the SABM Standards, Section 13, 5th edition for neonatal and pediatric patients were critical for statement development. An essential element was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were vetted by the Task Force. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The Educational Oversight Committee and the BOD approved the materials prior to submission to the Choosing Wisely® national team.
Working with this initiative, our selected recommendations and integrated materials will be further honed based on subsequent Campaign review. The list and supporting evidence, once approved, will form the basis of a manuscript for publication in a peer-reviewed journal. We foresee this as a vehicle for outreach to other professional societies, healthcare providers and patients.
Sources
Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, Gernsheimer T, Holcomb JB, Kaplan LJ, Katz LM, Peterson N, Ramsey G, Rao SV, Roback JD, Shander A, Tobian AA. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016 Nov 15;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 Feb;122(2):241-75
New HV, Berryman J, Bolton-Maggs PH, Cantwell C, Chalmers EA, Davies T, Gottstein R, Kelleher A, Kumar S, Morley SL, Stanworth SJ; British Committee for Standards in Haematology. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol. 2016 Dec;175(5):784-828
Valentine SL, Bembea MM, Muszynski JA, Cholette JM, Doctor A, Spinella PC, Steiner ME, Tucci M, Hassan NE, Parker RI, Lacroix J, Argent A, Carson JL, Remy KE, Demaret P, Emeriaud G, Kneyber MCJ, Guzzetta N, Hall MW, Macrae D, Karam O, Russell RT, Stricker PA, Vogel AM, Tasker RC, Turgeon AF, Schwartz SM, Willems A, Josephson CD, Luban NLC, Lehmann LE, Stanworth SJ, Zantek ND, Bunchman TE, Cheifetz IM, Fortenberry JD, Delaney M, van de Watering L, Robinson KA, Malone S, Steffen KM, Bateman ST; 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 Sep;19(9):884-898
