Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA Westwood, Massachusetts, United States
Background/Case Studies: To describe blood product utilization and preparation among subjects enrolled in the multicenter TITRE Trial of Indication-Based Red Blood Cell (RBC) Transfusion in Pediatric Extracorporeal Membrane Oxygenation (ECMO). TITRE is a randomized clinical trial enrolling patients age 6 years or younger supported on veno-arterial (VA) ECMO at 22 international centers. The objective of the trial is to determine whether indication-based RBC transfusion based on reduced tissue oxygen delivery compared with RBC transfusion based on institutional-specific hemoglobin thresholds reduces organ dysfunction by the time of decannulation and improves 1-year neurodevelopment in children receiving ECMO with target sample size of 228.
Study
Design/Methods: Transfused blood product collection method, additive solutions, processing including leukoreduction, irradiation, pathogen reduction and washing were collected for each product (whole blood, RBC, platelets, plasma, and cryoprecipitate) transfused in patients randomized from April 2023 through March 2024 (15 sites). Product preparation variation among sites was compared by chi-square test.
Results/Findings: Sixty-four subjects received a blood product transfusion. Median age at enrollment was 1.9 months (IQR 0.4-10.0), with 55% identified as male, 44% as white non-Hispanic and 28% had single ventricle congenital heart disease. Among blood products transfused, platelets were most frequent (468 units), followed by RBCs (394 units), plasma (258 units), cryoprecipitate (127 units) and 2 units of whole blood. RBC product preparation included leukoreduction (90%), irradiation (87%), and washing (10%). Platelet preparation included leukoreduction (91%), irradiation (47%), washing (0.3%) and pathogen reduction (47%). Additive solution use varied, with AS-3 most frequently used for RBC storage (32%) followed by CP2D (28%) and AS-1 (20%). For platelets, PAS was most common (41%) followed by ACDA (28%). Among the 8 sites with >10 RBC transfusions and complete product unit preparation data, there was significant site variation (p< 0.001): e.g., RBC leukoreduction (9-100%), RBC irradiation (9-100%); platelet irradiation (8-100%), and platelet pathogen reduction (0-100%) (Table 1). Ongoing TITRE enrollment will allow for inclusion of additional transfused units in analysis for presentation Conclusions: Interim analysis of blood product transfusion in the TITRE cohort identifies significant variation of blood product preparation and storage amongst participating sites. Ongoing enrollment and data collection will enrich this analysis of product preparation practice including age of products in a cohort of critically ill pediatric patients with frequent transfusion utilization.
