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Video Recording

Curated Top Poster

Transfusion Service

Curated Top Posters Tour: Novel Insights for Transfusion Practice

P-TS-1 - The Epidemiology of Pediatric Transfusion Reactions: Results from a Novel Multicenter Pediatric-Specific Donor-to-Recipient Vein-to-Vein Database

Monday, October 27, 2025
12:15 PM - 1:00 PM  PT
Room: SDCC Exhibit Hall F-H, AABB Learning Theater
CE: N/A
Background/Case Studies: Transfusions are a critical intervention for pediatric patients, yet the associated risks in children are poorly understood. It has been previously shown that children have higher rates of allergic and febrile nonhemolytic transfusion reactions (FNHTRs) compared to adults, but risk factors associated with and clinical management of pediatric transfusion reactions (TRs) are poorly defined. The goal of this study was to identify the epidemiology of TRs in a large cohort of transfused children.

Study

Design/Methods:

A prospective, observational study of reported TRs from April 2019 to December 2023 in patients < 18-years-old in 8 hospitals was performed as part of REDS-IV-P. Data collection forms and electronic medical records, as needed, were reviewed for all TRs reported to the transfusion service in the study period for: TR diagnosis with reported severity and imputability; product type (e.g., red blood cells, platelets, plasma, or cryoprecipitate); patient age, gender, race, and ethnicity; reported TR symptoms, premedications, and clinical management. Rates of TRs per 100,000 products transfused were calculated. A standard chi-square test was used for rate comparisons.

Results/Findings: Of 228,886 products transfused, 1,183 (0.5%) TRs were reported. TRs were most often reported in 5-11-year-olds (891/100K), but this varied by reaction type, with 2-5-year-olds having more FNHTRs than all other age groups. Platelet transfusions had the highest overall rates of TRs with allergic TRs being most common, whereas red cells had more FNHTRs than other TRs (Table 1). There were no differences in TR rates by sex or ethnicity, but Asian patients had the highest and Black patients had the lowest reported TR rates (617 vs. 398/100k). The most common symptoms for allergic, FNHTR, and TACO were urticaria (368/529, 70%), fever (559/579, 97%), and acute respiratory distress (21/24, 88%), respectively. Antihistamines (80%), antipyretics (68%), and diuretics (83%) were used to manage these reactions, respectively. Many patients (49%) did not receive premedications, regardless of reaction type. When TRs recurred, the reactions were often of the same type (78% after index allergic were allergic, 72% for FNHTRs).

Conclusions:

To our knowledge, this is the largest cohort of pediatric TRs. We establish significant differences in reaction rates by age, product, and race. We also highlight the most common symptoms and treatments for each TR. Further, premedications were not used in about ~1/2 of cases of reported TRs, and patients with more than 1 reaction tended to have repeated reactions of the same type. This study establishes a baseline for future studies to improve diagnostic and mitigation strategies for pediatric hemovigilance.