Kohorst Mira A, Khazal Sajad J, Tewari Priti, Petropoulos Demetrios, Mescher Benjamin, Wang Jian, Mahadeo Kris M, Kelley James M
Stem Cell Transplant and Cellular Therapy, Division of Pediatrics, 1515 Holcombe Blvd., Unit 0087, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Division of Electronic Health Record Analytics and Reporting, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
EClinicalMedicine. 2020 Sep 9;26:100514. doi: 10.1016/j.eclinm.2020.100514. eCollection 2020 Sep.
Active surveillance for transfusion reactions is critically important among pediatric patients undergoing chemotherapy. Among pediatric-adolescent-young-adult (AYA) hematology/oncology patients, who have been typically excluded from transfusion reaction studies, this profile remains poorly characterized.
We assessed the incidence and clinical characteristics of transfusion reactions ( = 3246 transfusions) in this population ( = 201 patients) at our center.
The incidence of adjudicated transfusion reactions was 2·04%. The incidence was higher for platelet (2·78%) compared to packed red blood cell transfusions (1·49%) ( = 0·0149). The majority (61·4%) of all reactions were classified as febrile non-haemolytic transfusion, while 35·7% were considered allergic, and 2·9% were classified as transfusion-associated circulatory overload. The incidence of transfusion reactions in patients who were pre-medicated was higher (2·51%) than in patients who were not (1·52%) ( = 0·0406). Sub-set analysis revealed a 3·95% incidence of adjudicated transfusion reactions among recipients of immune effector cells (IECs) ( = 3), all of which occurred during the potential window for cytokine release syndrome; two-thirds of these reactions were severe/potentially life-threatening.
The incidence of transfusion reactions among pediatric-AYA hematology/oncology patients may be lower than the general pediatric population. Patients with a prior history of transfusion reactions and those receiving platelet transfusions may be at higher risk for reaction. From our limited sample, IEC recipients may be at risk for severe transfusion reactions. Large multi-center prospective studies are needed to characterize transfusion reactions in this population. Appropriate characterization of reactions in this population may inform risk stratification and mitigate missed opportunities for prompt recognition and appropriate management.
None.
对于接受化疗的儿科患者，积极监测输血反应至关重要。在儿科 - 青少年 - 青年成人（AYA）血液学/肿瘤学患者中，输血反应研究通常将其排除在外，这一人群的输血反应情况仍未得到充分描述。
我们评估了本中心这一人群（201例患者）中3246次输血的输血反应发生率及临床特征。
判定的输血反应发生率为2.04%。血小板输血的发生率（2.78%）高于红细胞悬液输血（1.49%）（P = 0.0149）。所有反应中的大多数（61.4%）被归类为发热性非溶血性输血反应，而35.7%被认为是过敏反应，2.9%被归类为输血相关循环超负荷。接受预处理的患者输血反应发生率（2.51%）高于未接受预处理的患者（1.52%）（P = 0.0406）。亚组分析显示免疫效应细胞（IEC）接受者中判定的输血反应发生率为3.95%（n = 3），所有这些反应均发生在细胞因子释放综合征的潜在窗口期；其中三分之二的反应为严重/潜在危及生命的反应。
儿科 - AYA血液学/肿瘤学患者的输血反应发生率可能低于一般儿科人群。有输血反应既往史的患者以及接受血小板输血的患者可能发生反应的风险更高。从我们有限的样本来看，IEC接受者可能有发生严重输血反应的风险。需要开展大型多中心前瞻性研究来描述这一人群的输血反应。对这一人群反应的恰当描述可为风险分层提供依据，并减少及时识别和恰当处理方面的错失机会。
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