Massive Transfusion Protocols for Pediatric Patients: Current Perspectives

Figures & data

Table 1 Definitions of Massive Transfusion in Pediatric Literature^3,16,17,19-²¹

Author	Population	Definitions	Strengths	Limitations
Edwards et al 2012^Citation3	Iraqi and Afghani children admitted to a military facility with injuries from an explosive device	Any transfusion versus no transfusion, lack of definition for massive transfusion	Detailed description of blast injury patterns that increased mortality in children and adults	Only evaluated blast injured adults and children. This is an uncommon mechanism of pediatric injury in developed countries
Nosanov et al 2013^Citation19	Pediatric trauma patients who received blood within 24 hours	Greater than or equal to 50 percent of patient’s blood volume transfused within 24 hours	Relatively large cohort identified over several years at a large, United States pediatric trauma center	Includes head injured children which can obscure any mortality benefit from transfusion
Neff et al 2015^Citation16	Department of Defense Joint Theater Trauma Registry	Transfusion greater than or equal to 40 milliliters per kilogram of all blood products in 24 hours	Burns, drowning, isolated head injuries and those without an injury severity score were excluded	Combat injured children with blast and penetrating trauma predominating; 24 hour totals of blood products
Horst et al 2016^Citation20	Survey of forty six pediatric massive transfusion protocols	Institution Based, examples are greater than 40 milliliters per kilogram in 2 hours, more than 50 percent of blood volume in 2 hours and continued need for transfusion	Broad Response, Multiple Variables including ratios, hemostatic agents, massive transfusion protocol activation and compliance	Limited response from surveyed institutions by a variety of individuals with varying pediatric massive transfusion protocol experience
Cannon et al 2017^Citation21	Department of Defense Joint Theater Trauma Registry	Transfusion greater than or equal to 40 milliliters per kilogram in 24 hours	Burns, drowning and isolated head injuries and patients eighteen and over were excluded	Combat injured children were the only ones reviewed. The mechanism of injury is not as applicable in developed countries
Cunningham et al 2019^Citation17	Pediatric Trauma Quality Improvement Program data	Transfusion greater than or equal to 40 milliliters per kilogram in 24 hours	Large cohort, multi-institution data set; burns, dead on arrival and non-survivable injuries excluded	Retrospective, limited by data in the Trauma Quality Improvement Program database

Figure 1 Estimated blood volume in milliliters/kg from preterm infants to childhood. Data from Coté et al.²²

Table 2 Anticoagulants and Additives: Whole Blood versus Component Therapy

	Total Volume	Anticoagulants and Additives
PRBC	360 ml	120 ml
FFP	240 ml	50 ml
Apheresed PLT	300 ml	35 ml
Whole blood	450 ml	63 ml

Note: Data from Spinella et al.⁴³

Abbreviations: PRBC, packed red blood cells; FFP, fresh frozen plasma; PLT, platelets.

Table 3 Comparing Whole Blood to Component Therapy

	Whole Blood	Component Therapy (1 PRBC, 1 FFP, 1 PLT)
Volume	570 ml	660 ml
Hematocrit	33–43%	29%
Platelets	130,000–350,000	88,000
Coagulation factors	86%	65%

Note: Data from Murdock et al.⁴⁴

Abbreviations: PRBC, packed red blood cells; FFP, fresh frozen plasma; PLT, platelets.

Edwards MJ, Lustik M, Eichelberger MR, Elster E, Azarow K, Coppola C. Blast injury in children: an analysis from Afghanistan and Iraq, 2002–2010. J Trauma Acute Care Surg. 2012;73(5):1278–1283. doi:10.1097/TA.0b013e318270d3ee23117384

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