Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure

• DOI: 10.1111/ctr.13819
• Publication Date: 2020-02-10T02:59:21Z
• Authors: Angela Lee; Julianne Mendoza; Aleah L. Brubaker; Daniel J. Stoltz; Rebecca McKenzie; Clark A. Bonham; Carlos O. Esquivel; Amy E. Gallo
• Keywords: Cryoprecipitate

Abstract Introduction Transfusion protocols are not well‐studied for pediatric patients with acute liver failure (ALF). This study evaluates the utility of an international normalized ratio (INR)‐based transfusion threshold these patients. Methods Forty‐four ALF from 2009 to 2018 were reviewed and divided into two groups: (a) a group including between 2015 who transfused INR above 3.0, per institutional policy (n = 30), (b) post‐threshold after through based on clinical judgment 14). Preoperative INRs, preoperative transfusions, intraoperative early reoperation, renal function, graft function deaths compared. Results Liver severity was similar groups. Threshold had lower average prior transplantation, 2.8 (range 1.8‐3.8) vs 4.4 2.1‐9.0), respectively ( P .01). Twenty‐six (87%) received FFP compared seven (50%, .0088). Two (7%) cryoprecipitate five (36%, .014). The incidence pre‐transplant bleeding, operative 1‐year patient survival did differ significantly. Conclusion Clinical INR‐based transfusions increase perioperative complications in children ALF.