Dr. Cassandra Josephson from Emory University in Atlanta joins Dr. Chaffin to discuss her “Five Top Things You Should Know about Pediatric Transfusion.” Dr. Josephson is a very widely published and respected authority on pediatric transfusion (she is the co-author of the chapter “Neonatal and Pediatric Transfusion” in the current edition of the AABB Technical Manual, among many other publications). Honestly, she’s just terrific! She was kind enough to join me for a far-ranging conversation on five top things you need to know if you are to be involved with pediatric transfusion in 2016! Note that this is not intended to be the only things you need to know, and this is just the first in an occasional series on pediatric transfusion issues, so enjoy this one and be ready for more down the line!
Use the player above to listen to Episode 012 of the BBGuy Essentials Podcast!
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Dr. Josephson serves as a consultant to the following companies: Immucor, Octapharma, and Biomet Zimmer.
- 02:00: Intro to Dr. Josephson
- 09:45: Top Five Things #1: “The Volumes Vary”
- 19:10: Out of group plasma risk discussion
- 20:25: Top Five Things #2: “Predicting Platelet Effect in Neonates, Pediatric Oncology, and Stem Cell Patients”
- 22:30: Description of new paper showing no benefit of platelet transfusions in preventing neonatal intraventricular hemorrhage!
- 25:05: PLADO subanalysis showing platelet count does not predict bleeding in children
- 32:40: Top Five Things #3: “Cleaning House; Irradiation and “CMV-safe” products”
- 35:55: Neonates at risk for TA-GVHD
- 39:28: CMV-safe blood products and neonatal CMV transmission
- 45:37: Optimal CMV prevention strategy
- 49:30: Top Five Things #4: “An Ounce of Prevention Makes RBC Transfusion Possible and Lifesaving”
- 53:45: Matching RBC transfusions in sickle cell disease
- 60:00: Future danger of allowing pediatric sickle cell patients to make alloantibodies
- 65:20: Top Five Things #5: “A Look at Hemolytic Disease of the Fetus and Newborn”
- 67:35: ABO Hemolytic Disease of the Newborn
Further Reading (in order mentioned):
- Hendrickson JE et al. Coagulopathy is Prevalent and Associated with Adverse Outcomes in Transfused Pediatric Trauma Patients. J Peds 2012;160(2):204-9
- Sparger KA et al. Platelet Transfusion Practices Among Very-Low-Birth-Weight Infants. JAMA Pediatrics 2016 (early view online May 23, 2016).
- Slichter SJ et al. Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage. N Engl J Med 2010;362:600-13.
- Josephson CD et al. Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypo proliferative thrombocytopenia. Blood 2012:120(4):748-60.
- Josephson CD et al. Blood Transfusion and Breast Milk Transmission of Cytomegalovirus in Very Low Birth Weight Infants. JAMA Pediatrics 2014;168(11):1054-62.
- Delaney M et al. Postnatal cytomegalovirus infection: a pilot comparative effectiveness study of transfusion safety using leukoreduced-only transfusion strategy. Transfusion 2016 (early view online April 15, 2016).
- Vichinsky EP et al. Prospective RBC phenotype matching in a stroke-prevention trial in sickle cell anemia: a multicenter transfusion trial. Transfusion 2001;41:1086-92.
- Chou ST et al. High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors. Blood 2013;122(6):1062-71.
- Nickel RS et al. Impact of red blood cell alloimmunization on sickle cell disease mortality: a case series. Transfusion 2016;56(1):107-14.
- McLaughlin JF and Ballas SK. High mortality among children with sickle cell anemia and overt stroke who discontinue blood transfusion after transition to an adult program. Transfusion 2016;56(5):1014-21.
- Winkler AM and Josephson CD. Transfusion practices for patients with sickle cell disease at major academic medical centers participating in the Atlanta Sickle Cell Consortium. Immunohematology 2012;28(1):24-6.