Transfusion practices, thresholds, and complications in pediatric oncology patients: a single-center prospective longitudinal observational study.

Abstract

This study aimed to evaluate the frequency, indications, pre-transfusion threshold values, associated risk factors, and complications of blood product transfusions in pediatric oncology patients to contribute to the development of evidence-based, standardized transfusion strategies. This single-center, prospective observational study included 41 pediatric oncology patients aged 1 to 18 years who received red blood cell (RBC), platelet, or fresh frozen plasma (FFP) transfusions between June 2023 and June 2024. Patients were followed throughout their treatment and for six months after their final transfusion. Among 404 transfusions (215 RBC, 183 platelet, 6 FFP), the mean number per patient was 9.78 ± 9.2. Pre-transfusion platelet thresholds were significantly higher in the leukemia/lymphoma group than in the solid tumor group (23,892 ± 11,773/mm³ vs. 16,669 ± 11,921/mm³; p < 0.001), while RBC hemoglobin thresholds were similar (7.4 ± 0.6 vs. 7.3 ± 0.8 g/dL; p = 0.67). Advanced-stage disease (p = 0.04) and relapsed or refractory disease (p = 0.026) were associated with increased RBC transfusion requirements. Acute reactions occurred in 12.4% of transfusions, most (84%) being febrile nonhemolytic reactions. Premedication did not prevent reactions (p = 0.6). During long-term follow-up, serum ferritin exceeded 1000 ng/mL in 45.7% of patients. Transfusion management varies by diagnosis, with platelet thresholds in hematologic malignancies maintained higher than literature recommended. Advanced-stage and relapsed or refractory disease increase the transfusion burden. The high incidence of acute reactions and iron overload underscores the need for transfusion safety, long-term monitoring, and standardized, evidence-based transfusion strategies in pediatric oncology.