tailieunhanh - Ebook Pediatric critical care medicine (Volume 3: Gastroenterological, endocrine, renal, hematologic, oncologic and immune systems - 2nd edition): Part 2

Part 2 book "Pediatric critical care medicine" presents the following contents: The hematologic system in critical illness and injury, oncologic disorders in the PICU, the immune system in critical illness and injury, secondary immunodeficiency syndromes. | Part IV The Hematologic System in Critical Illness and Injury Jacques Lacroix Transfusion Medicine 19 Marisa Tucci Jacques Lacroix France Gauvin Baruch Toledano and Nancy Robitaille Abstract Anemia is common in pediatric intensive care units PICU . Severe anemia can significantly increase the risk of death. Only a red blood cell RBC transfusion can rapidly treat a severe anemia. In stable PICU patients RBC transfusion is probably not required if the hemoglobin concentration is above 7 g dL unless the patient has a cyanotic cardiac condition. The trigger or goal that should be used to direct RBC transfusion therapy in unstable critically ill children remains undetermined although some data suggest that RBC transfusion may help in the early treatment of unstable patients with sepsis if their ScvO2 is below 70 after mechanical ventilation fluid challenge and inotropes vasopressors perfusions have been initiated. Plasma and platelets are used to prevent or to treat hemorrhage attributable to a coagulopathy thrombocytopenia or platelet dysfunction. The risks and benefits of plasma and platelet concentrates in PICU patients are discussed. There is almost no evidence at the present time that might permit a strong recommendation with regard to the use of plasma and platelets in PICU. Good knowledge of transfusion reactions is required in order to appropriately estimate the cost benefit ratio of transfusion. Nowadays non-infectious serious hazards of transfusion NISHOT are more frequent and more challenging for pediatric intensivists than transfusion-transmitted infectious diseases. The decision to prescribe a transfusion must be tailored to individual needs and repeated clinical evaluation of each critically ill child. Keywords Anemia Erythrocyte Plasma Platelets Transfusion M. Tucci MD Department of Pediatrics Sainte-Justine Hospital University of Montreal 3175 Cote Sainte-Catherine Montreal QC H3T 1C5 Canada e-mail J. Lacroix MD .