A single center experience of transfusion related adverse reaction in pediatric patients with malignant solid and hematological tumors

Background This study aimed to analyze the clinical characteristics and incidence of transfusion related adverse reactions (TRARs) in pediatric patients with malignant solid and hematological tumors. Methods A retrospective analysis was conducted on 34,195 blood transfusions (RBC: 41.0%; PLT: 40.7%; FFP: 16.0%; cryoprecipitate: 2.3%) among 9,129 pediatric patients. TRARs were classified and severity graded according to the Chinese Haemovigilance Network criteria. Statistical comparisons were made between serious (n=37) and non-serious (n=194) TRAR cases. Results The overall TRAR incidence was 0.68% (231/34,195), with PLT-associated TRARs being most frequent (1.25%, 174/13,915). Allergic transfusion reactions (ATRs) dominated (95.7%, 221/231), followed by febrile non-hemolytic reactions (FNHTRs, 3.5%, 8/231). Serious TRARs (16.0%, 37/231) primarily involved ATRs (91.9%, 34/37), presenting with respiratory/gastrointestinal symptoms (41.2%) or anaphylactic shock (14.7%). Significant risk factors for serious TRARs included PLT transfusion (p=0.011), allergy history (p=0.048), and prophylactic premedication (p<0.001). Conclusions Pediatric patients with malignant solid and hematological tumors exhibit a high TRAR incidence, particularly with PLT transfusions. ATRs constitute the majority, underscoring the need for vigilant monitoring and evidence-based prophylaxis. The inefficacy of routine premedication highlights the necessity for tailored transfusion strategies. Further research is warranted to optimize platelet product selection and TRAR management protocols in this vulnerable population.