Thread by @TransfusionWM

Excellent session on emergency paediatric transfusion #AABB20. Cyril Jacquot talking on pre hospital transfusion and summarising the literature.
28 day mortality following haemorrhage is higher in children than adults (unpublished data and substudies from PROPPR and PROMMTT)

Observational studies of large numbers of patients but with only very small numbers of paediatric patients suggest that pre hospital blood is not associated with an excess of transfusion reactions and in some studies is thought to have improved survival.

Whole blood, group O, high titre neg, used in paediatrics in Pittsburgh appears to be safe with no haemolysin-mediated haemoylsis in non group O patients (Leeper et al JAMA Pediatrics 2018) ncbi.nlm.nih.gov/pmc/articles/P…

Next is Prof Josephson on trauma coagulopathy in children. This definitely occurs and is associated with high mortality
sciencedirect.com/science/articl…
Abnormal coagulation occurred in almost all injury types. Degree of increase in PT and reduction in fg predicts for mortality.

Challenges in paeds major haemorrhage protocols include appropriate volumes to be transfused and type of component. They published their experience here, demonstrating improved ratios and reduced time to transfusion onlinelibrary.wiley.com/doi/abs/10.111…

Next up Prof Spinella on Group O low titre whole blood which has a number of advantages over component therapy:
1.stored at 4 degrees therefore platelets are activated
2.more potent (3x more diluent with component therapy vs WB)
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3.increased storage duration compared to room temp platelets
4.less bacterial contamination risk
5.logistical advantages

However risk of haemolysis in non group O patients, and potential risk of over resuscitation.
Safety profile is demonstrated here:
pubmed.ncbi.nlm.nih.gov/31464874/

Improved survival with WB has been demonstrated, with impaired platelet function being associated with higher mortality. Is it the cold stored platelets in the WB that made the difference? Could outcomes be related to faster delivery of plasma and platelets in the WB setting?

Questions in paeds for whole blood include appropriateness of use of O pos blood for girls. Interesting ethical dilemma and the numbers have been worked through here, demonstrating a 0.4% risk of fetal demise onlinelibrary.wiley.com/doi/abs/10.111…

Also need to think about storage age of WB, a min age of children who should receive WB and many other elements. Paedatric trial being planned but will take time to report. Is it ethical to wait for completion to implement WB for children in light of the available evidence?

Thank you for a thought provoking and thorough walk through the evidence in this area!