From
StayCurrentMD
Restrictive Transfusion Protocols: Practice Gap discussion at Update Course 2018
With Dr. Craig Lillehei · hosted by Dr. Todd Ponsky
Chapter 1 of 4 · Fundamentals
PDC introduction
Introduction to APSA Professional Development Committee and Practice Gaps
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
There are over 900 items in the American Board of Surgery scope of pediatric surgery curriculum
There are over 1200 questions in the APSA online continuing medical education platform called Expert
There are over 1500 learning objectives in the pediatric surgery trainee curriculum
Over 7000 new pediatric surgery articles are published in the medical literature every year
The pediatric surgery online reference NAT (Not a Textbook) has over 12,000 different learning objectives
A practice gap is defined as the distance between what is best practices or evidence-based and what you should be doing and what actually happens
A restrictive transfusion protocol means blood transfusion only when the hemoglobin goes under 7
Restrictive transfusion protocols are increasingly becoming the norm for NICUs across the US and globally
Blood transfusions carry morbidity associated with them
In the adult literature, a number of studies show that the more transfusions, the higher the mortality, so places with liberal transfusion policies pay a toll for that
There is an incidence of transfusion-associated NEC in preemies
When transfusing neonates, you are transfusing with adult hemoglobin versus fetal hemoglobin, so the oxygen dissociation curve is affected adversely
Pediatric surgeons and neonatologists worry about white cell antigens and primarily try to use leukocyte-reduced products for transfusion
The old thinking was to keep hemoglobin around 10 or thereabouts
There is no difference in mortality or adverse events with restrictive transfusion strategy in PICUs
In the NICU, results are somewhat mixed and more complicated, especially in preemies
In some studies there has been evidence of a higher rate of periventricular leukomalacia and other adverse neurologic outcomes in preemies with restrictive transfusion protocols
In preemies and very small preemies, there are studies on both sides of the coin regarding restrictive transfusion outcomes, but clearly mortality is not affected
The evidence for restrictive transfusion protocols in the PICU is pretty good
The evidence for restrictive transfusion protocols on the floor is pretty good
Depending on who you talk to, they think there's good evidence in the NICU for restrictive transfusion protocols, but there are conflicting studies
For pediatric surgery, there's not a lot of really good evidence or good guideline-based recommendations