Transfusion management strategies: a survey of practicing pediatric hematology/oncology specialists

BACKGROUND: Little is known about the criteria used by pediatric oncologists for the transfusion of red blood cells and platelets to pediatric oncology patients. PROCEDURE: Data regarding red blood cell and platelet transfusion practices were collected with an internet-based survey of physician members of the American Society for Pediatric Hematology/Oncology (ASPH/O). Respondents were asked to define platelet and red blood cell transfusion thresholds in a variety of clinical scenarios, and to describe criteria for dealing with cytomegalovirus (CMV) transmission from blood products, platelet dosing strategies, and prevention of RhD alloimmunization. RESULTS: The overall response rate was 31.4% (264 of 841). Of the respondents, 76% indicated that their institution had defined criteria for acceptable transfusion practice; of these respondents, 114 (57%) indicated that there were special guidelines for pediatric oncology patients. Examination of the distribution of threshold platelet counts and hemoglobin levels that would prompt transfusion indicated a wide range of transfusion practice in commonly encountered clinical scenarios. Similar variability in practice was evident in platelet dosing strategies, CMV prevention strategies, and in the use of anti-D in RhD-negative patients who received RhD-positive platelets. CONCLUSIONS: This current survey demonstrates that transfusion practices vary widely among pediatric hematology/oncology specialists and that prospective clinical trials may be necessary to determine optimal criteria for blood product support in pediatric oncology patients.