Introduction:
One of the most frequent procedures in hospitals is blood transfusions, which is life-saving therapy. Transfusions should be regarded as a form of tissue transplantation since they involve the transfer of blood or its constituent parts from one person to another. Any adverse event associated with transfusion that takes place during or after the transfusion of blood or one of its components is referred to as a transfusion reaction, whether it is acute or delayed. Acute transfusion reactions include acute hemolytic transfusion reactions (AHTR), allergic transfusion reactions (ATRs), febrile non-hemolytic transfusion reactions (FNHTR), transfusion-associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI), and metabolic reactions. These reactions happen within 24 hours of the transfusion.
The most typical symptoms of ATRs, which are a common type of acute transfusion reaction, include urticaria (a skin condition that causes itchy, raised, and red welts), pruritus (itching), an erythematous rash (red rash), angioedema (a swelling that occurs beneath the skin), bronchospasm (a sudden constriction of the airways in the lungs), and or hypotension (low blood pressure). Anaphylaxis is a less frequent but more serious ATR symptom. Anaphylactic reactions to blood products occur 1 in 20000 to 50000 times. It is unclear how donor, product, and or recipient factors relate to the mechanisms of underlying ATRs.
Children and adults experience transfusion-related adverse reactions at different rates and distributions. Pediatric patients experience more ATRs than adults do, particularly after receiving platelet and red blood cell transfusions. In contrast to adult ATRs, pediatric ATRs are less well understood. Complications from blood transfusions are not subject to any international norms or standards for diagnosis or treatment.
What Are the Implicated Blood Products In Pediatrics?
RBC (red blood cell) transfusions made up about 60 percent, while plasma and platelet transfusions made up about 30 percent of transfusion reactions in both adults and children. Less than three percent of transfusion reactions were associated with cryoprecipitate. Platelet transfusions, marked by RBCs and then plasma, was associated with the highest rate of transfusion reactions in both the adult and pediatric populations. In either population, there were no transfusion reactions that were seen to be related to cryoprecipitate. The two age groups were compared, and the results showed that pediatric patients had a similar incidence of transfusion reactions related to plasma but a significantly greater incidence of transfusion reactions related to platelet and RBC transfusions.
How Is Transfusion Reaction Classified?
The majority of transfusion reactions (61 percent) were categorized as febrile non-hemolytic transfusion reactions (FNHTR), while 35 percent of reactions were allergic and 29 percent were associated with circulatory overload (TACO). Both of these TACO transfusion reactions happened in HCT (hematocrit test) or IEC patients (one following a double cord blood allogeneic transplant and the other following IEC administration). Both of these patients displayed signs of fluid volume overload, including worsening respiratory distress, a positive fluid balance, pulmonary edema, and an increase in the need for oxygen. Both of these patients were not taking diuretics or had a history of TACO. None of the transfusions given to patients with benign haematologic diseases resulted in FNHTR, and two of them caused an allergic reaction.
The rates of NHFTRs and allergic transfusion reactions were comparable in the HCT or IEC, leukemia or lymphoma, and solid tumor groups. Five of the 70 total reactions (or 71 percent of reactions) were potentially fatal. IEC patients experienced one severe allergic reaction, pediatric oncology patients experienced two severe FNHTRs (brain tumor and acute lymphocytic leukemia), and HCT or IEC patients experienced two TACOs (one cord blood recipient and one IEC recipient). No transfusion reaction was connected to a fatality.
What Is The Frequency of Transfusion Reactions In Children As Compared To Adults?
Pre-medication and platelet transfusions were linked to a higher incidence of transfusion reactions. Although it appeared that younger kids had a higher prevalence of reactions, they might not have had enough power to detect significance. The most typical reaction seen was febrile non-hemolytic transfusion reactions. Potentially fatal reactions were uncommon, but they were more frequent in IEC recipients. Immune effector cells and checkpoint inhibitors are examples of cellular and immunotherapies that have revolutionized oncology, but they also have unique side effects and may cause symptoms that are similar to those of transfusion reactions.
The following signs and symptoms were present during or within six hours after the transfusion: fever, chills or rigors, nausea or vomiting, anxiety, diarrhea, a sense of impending doom, loss of consciousness, hypotension, hypertension, tachycardia, edema, rash, flushing, urticaria, pruritus, cyanosis, pain at the infusion site, abdominal pain or cramps, chest pain or chest tightness, flank pain, inflammation of the lips, tongue, or mucous membranes, bleeding, low back pain, new-onset headache, dyspnea or labored breathing, wheezing, stridor, shortness of breath, tachypnea, swollen lips, tongue, or mucous membranes, difficulty speaking, or any other alarming symptoms.
Both generally and in the inpatient setting, adult patients were more likely than pediatric patients to receive a transfusion. When normalized to inpatient visits, the reaction rate between adults and children was essentially the same. According to the study, children (0.53 percent) are more likely to experience negative blood transfusion outcomes than adults (0.26 percent). According to Gao et al.15, the overall rate of negative reactions was 0.4 percent, which is both higher and lower than that of adults and children.
But when normalized to all visits, the pediatric population showed a reaction rate that was roughly 1.5 times higher than that of the adult population. The adult population experienced ten different types of transfusion reactions compared to the pediatric population.
Conclusion:
In conclusion, the occurrence of transfusion reactions among pediatric-AYA (adolescent and young adult) hematology or oncology patients may be lower than that of the general pediatric population and comparable to that of the reported general adult population. Patients receiving platelet transfusions and those with a history of transfusion reactions may be more susceptible to reactions. Large multi-center prospective studies are required to describe this sub-population further because IEC recipients may be at an increased risk for serious transfusion reactions. Emerging data might make it possible to develop an improved risk stratification system, identify transfusion reactions earlier and more accurately, and facilitate proper management. Both in adults and children, there are different rates of transfusion reactions. It is necessary to have guidelines for kids.
