Research

A review of blood transfusions in a trauma unit for young children

M Salverda, N Ketharanathan, M van Dijk, E Beltchev, H Buys, A Numanoglu, A B van As

Abstract


Background. Trauma is the leading cause of mortality and morbidity worldwide. Blood transfusions play an incremental role in the acute phase, yet practice varies owing to variations in transfusion thresholds and concerns about potential complications, especially in children.

Objectives. To evaluate protocol adherence to blood transfusion thresholds in paediatric trauma patients and determine the degree of blood product wastage, as defined by discarded units.

Methods. A retrospective, descriptive study of trauma patients (age 0 - 13 years) who received a blood transfusion in the trauma unit at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa, over a 5.5-year period (1 January 2009 - 1 July 2014). Haemoglobin (Hb) transfusion thresholds were defined as 10 g/dL for neurotrauma patients and patients requiring skin grafting or a musculocutaneous flap (group 1). All other trauma patients had an Hb transfusion threshold of 7 g/dL (group 2).

Results. A total of 144 patients were included (mean age 5.2 years (standard deviation (SD) 3.3), 68.1% male). The mean Hb increase after transfusion was 3.5 g/dL (SD 1.7). Adherence to the transfusion Hb threshold protocol was 96.7% for group 1 v. 34.0% for group 2. No complications were reported. Average blood wastage was 3.5 units per year during the study period.

Conclusions. Adherence to paediatric blood transfusion protocol was low in the Hb threshold group <7 g/dL. However, transfusion-related complications and wastage were minimal. Further prospective research is required to determine optimal blood transfusion guidelines for paediatric trauma patients.


Authors' affiliations

M Salverda, Department of Intensive Care and Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands

N Ketharanathan, Department of Intensive Care and Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands

M van Dijk, Department of Intensive Care and Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands; Department of Paediatric Surgery, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

E Beltchev, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

H Buys, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

A Numanoglu, Department of Paediatric Surgery, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

A B van As, Department of Paediatric Surgery, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

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Keywords

Blood transfusion; Children; Trauma; Injury

Cite this article

South African Medical Journal 2017;107(3):227-231. DOI:10.7196/SAMJ.2017.v107i3.11307

Article History

Date submitted: 2017-02-27
Date published: 2017-02-27

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