2022 Volume 59 Issue 3 Pages 239-247
Blood transfusion is an important supportive therapy for children with cancer. However, no clear blood transfusion adaptation criteria have been established in Japan. According to the blood transfusion indication criteria for children with cancer in the pediatric blood transfusion guidelines in other countries, the hemoglobin level should be 7–8 g/dL for red blood cell transfusion, and the platelet count should be 10,000–20,000/μL for platelet transfusion to prevent bleeding. Although these are not based on sufficient scientific evidence, many facilities in Japan refer to these values. In contrast, a judgment based on the medical condition of children is necessary in some cases, while also considering the safety of blood transfusion products, without being overly caught up in these indicators. In particular, much debate about blood transfusion still exists for terminal pediatric cancer patients who are judged difficult to cure. For patients with hematologic cancers such as leukemia, blood transfusion is essential for maintaining the quality of end-of-life (EOL) care, although it is a barrier to staying at home for children desiring home care. Although blood transfusion in any situation should be performed safely, there are no reports on the indications for home blood transfusions and safe implementation systems for childhood cancer patients during EOL care in Japan. Herein, we summarize the current status and adverse effects of pediatric blood transfusion and indications for blood transfusion in pediatric cancer patients, and we consider the indications and issues of home blood transfusion for terminal children with cancers.
