About SMaRT Transfusion

About

Red Blood Cell (RBC) transfusion can be lifesaving in hemorrhagic shock or in severe anemia (hemoglobin levels < 5.0 g/dL). RBC transfusion is intended to improve oxygen delivery, however storage of transfused RBCs may reduce capacity to deliver oxygen. RBC transfusion has been associated with serious hazards, as well as increased morbidity and mortality, particularly in critically ill children, raising important safety concerns.

SMART Transfusion is a tool that provides clinical guidance around RBC transfusion. The tool was developed as part of the Transfusion and Anemia eXpertise Initiative (TAXI), an international effort to create evidence-based or expert-based (when evidence was lacking) transfusion guidelines for critically ill children. A systematic review informed development of these guidelines. Agreement on and grading of guidelines utilized a rigorous, valid process. Additional information on specific recommendations and sub-populations is available in "References".

References

Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Valentine SL, et al
Pediatr Crit Care Med. 2018 Sep; 19(9):884-898. doi: 10.1097/PCC.0000000000001613
PMID: 30180125

Supplementary References:

Recommendations on RBC Transfusion in General Critically Ill Children Based on Hemoglobin and/or Physiologic Thresholds From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Doctor A, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S98-S113. doi: 10.1097/PCC.0000000000001590
PMID: 30161064

Recommendations on RBC Transfusion in Critically Ill Children With Nonlife-Threatening Bleeding or Hemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Karam O, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S127-S132. doi: 10.1097/PCC.0000000000001605
PMID: 30161067

Recommendations on RBC Transfusions for Critically Ill Children With Nonhemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Muszynski JA, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S121-S126. doi: 10.1097/PCC.0000000000001620
PMID: 30161066

Recommendations on RBC Transfusions in Critically Ill Children With Acute Respiratory Failure From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Demaret P, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S114-S120. doi: 10.1097/PCC.0000000000001619
PMID: 30161065

Recommendations on RBC Transfusion in Critically Ill Children With Acute Brain Injury From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Tasker RC, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S133-S136. doi: 10.1097/PCC.0000000000001589
PMID: 30161068

Recommendations on RBC Transfusion Support in Children With Hematologic and Oncologic Diagnoses From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Steiner ME, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S149-S156. doi: 10.1097/PCC.0000000000001610
PMID: 30161070

Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Cholette JM, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S137-S148. doi: 10.1097/PCC.0000000000001603
PMID: 30161069

Recommendations on the Indications for RBC Transfusion for the Critically Ill Child Receiving Support From Extracorporeal Membrane Oxygenation, Ventricular Assist, and Renal Replacement Therapy Devices From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Bembea MM, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S157-S162. doi: 10.1097/PCC.0000000000001600
PMID: 30161071

Recommendations on Selection and Processing of RBC Components for Pediatric Patients From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Zantek ND, et al
Pediatr Crit Care Med. 2018 Sep; 19(9S Suppl 1):S163-S169. doi: 10.1097/PCC.0000000000001625
PMID: 30161072