Infants and children are NOT just “little adults!” Dr. Cassandra Josephson shares 5 principles you must know about pediatric transfusion.
About My Guest:
Dr. Cassandra Josephson is one of only a few physicians in the United States trained and board-certified in Pediatrics, Pediatric Hematology/Oncology, and Blood Banking/Transfusion Medicine. She is a Professor in the Departments of Pathology and Lab Medicine and Pediatrics at Emory University in Atlanta, GA. She is the medical director of the blood/tissue banks, and apheresis services at Children’s Healthcare of Atlanta and Director of Clinical Research in the Emory Center for Transfusion and Cellular Therapies. She is also the co-author of the “Neonatal and Pediatric Transfusion” chapter in the 18th edition of the AABB Technical Manual, among many other publications.
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.