(P-TS-105) Toward Demonstrating Children are not Small Adults: Transfusion Reaction Rates from a Novel Multicenter Pediatric-Specific Donor Vein-to-Recipient Vein Database

Sunday, October 20, 2024

12:00 PM - 1:00 PM

Presenting Author(s)

Sarah Vossoughi, MD, RN (she/her/hers)

New York Blood Center Enterprises, New York, United States

Background/Case Studies: Pediatric patients are often transfused, yet the associated risks remain uncertain. Previous studies suggest that pediatric patients may have a higher rate of certain transfusion reactions (TRs) compared to adults, but the etiology of this phenomenon is unknown. There is a clinical need to establish data-driven, pediatric-specific TR incidence rates. We hypothesized that febrile nonhemolytic TR (FNHTR) and allergic TRs would be greater than are observed in adults.

Study

Design/Methods: We performed a prospective 8-hospital, including 3 large tertiary children’s hospitals, observational study of passively reported TRs (patients < 18 years) from April 19, 2019 to December 31, 2023. The following aspects were captured for each TR: diagnosis with severity and imputability; product type (e.g., red blood cells, platelets, plasma, or cryoprecipitate); volume transfused; TR symptoms; patient age, gender, weight, and infusion rate. Crude incidence rates of TRs per 100,000 products transfused were calculated, and a chi-square test was used to compare incidence rates with those from previously published data.

Results/Findings: Of 235,539 products transfused to approximately 22,000 recipients, 1,354 (0.6%) TRs were reported. Of these, 977 were deemed as definitely, possibly, or probably related to the transfusion (415 per 100,000 products). Reactions were predominantly reported from red blood cells (493, 51%) and platelets (446, 46%), and most reactions reported were determined to be non-severe (939, 96%). The most common imputable TRs per 100,000 products were allergic (208), FNHTR (191), and transfusion associated circulatory overload (TACO, 12). Transfusion associated dyspnea (TAD, 3) and transfusion related acute lung injury (TRALI, 0.4) were infrequently reported.

Conclusions:

This is the first report from a prospective, multicenter, observational pediatric-specific vein-to-vein database. Compared to TRs reported from the predominantly adult-focused National Healthcare Safety Network Hemovigilance Module, our study reveals that pediatric blood transfusion recipients have a 1.9 fold higher per 100,000 rate of TRs than all ages data (415 vs. 219, p< 0.001); with higher rates in pediatric recipients for allergic (208 vs. 92, p< 0.001) and FNHTR (191 vs 91, p< 0.001) in our cohort, but not for TACO (12 vs. 11, p=0.8), TAD (3 vs. 4, p=0.7), or TRALI (0.4 vs. 0.7, p=0.9). The similar overall rates for TACO, TRALI, and TAD are intriguing and may be due to poor recognition/underreporting. This study establishes a baseline for future in-depth studies on the effect of pediatric reaction prevalence, product dose, and patient age with the ultimate goal of developing targeted mitigation strategies.