Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany; German Working Group on Paediatric Anesthesia (WAKKA); Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
Dtsch Arztebl Int. 2024 Jan 26;121(2):58-65. doi: 10.3238/arztebl.m2023.0243.
Approximately 1% to 2% of all hospitalized children receive a transfusion of blood products, in Germany as in other countries. High-quality scientific evidence on transfusions in children is scarce. The available evidence is discussed in this review.
This review is based on publications on blood product transfusions in children that were retrieved by a literature search, including clinical studies, international guideline recommendations, the recommendations of the German cross-sectional guideline, and results of other recent, relevant publications.
A restrictive transfusion strategy is recommended for all children, including those who are critically ill. Randomized controlled trials have shown that a restrictive strategy for erythrocyte concentrate transfusion in the intensive care unit is safe for children, including neonates. No robust data are available to enable the definition of a suitable threshold for the intraoperative administration of red blood cell concentrates in children undergoing extracardiac surgery. On the basis of studies from pediatric intensive care units, transfusions for hemodynamically stable children with a hemoglobin concentration of more than 7 g/dL are recommended only in exceptional cases. Therapeutic plasma is not recommended as volume replacement, except in massive transfusion. Platelet concentrate transfusions are indicated in case of active hemorrhage, and only rarely for prophylaxis.
There is a broad lack of evidence from randomized controlled trials concerning the indications for transfusions in children. A restrictive transfusion strategy, which has been found safe in the intensive-care setting, is favored by the guidelines in the perioperative setting as well. Further studies are needed to evaluate transfusion triggers and indications for all types of blood products, especially therapeutic plasma. Until more evidence is available, physicians should be aware of what the current evidence supports, and blood products should be given restrictively, and not prophylactically.
在德国和其他国家一样，约有 1%至 2%的住院儿童需要输注血液制品。关于儿童输血的高质量科学证据非常有限。本文对现有证据进行了讨论。
本综述基于检索到的儿童血液制品输注相关文献，包括临床研究、国际指南建议、德国横断面指南的建议以及其他近期相关出版物的结果。
建议对所有儿童（包括危重症儿童）采取限制性输血策略。随机对照试验表明，重症监护病房红细胞浓缩液的限制性输血策略对儿童（包括新生儿）是安全的。目前尚无可靠数据可确定在接受心脏外手术的儿童中术中给予红细胞浓缩液的合适阈值。根据儿科重症监护病房的研究，仅在特殊情况下才建议对血红蛋白浓度超过 7 g/dL 的血流动力学稳定的儿童进行输血。不建议将治疗性血浆作为容量替代物，除非是大量输血。血小板浓缩液适用于有活动性出血的情况，仅在极少数情况下用于预防。
关于儿童输血适应证，随机对照试验证据非常有限。在围手术期，指南也倾向于采用在重症监护环境中已被证明安全的限制性输血策略。需要进一步研究来评估所有类型血液制品的输血触发因素和适应证，尤其是治疗性血浆。在更多证据出现之前，医生应该了解当前证据所支持的内容，并应限制而不是预防性地使用血液制品。
