Transfusion of blood components is a critical – life-saving - part of the care of children with hematologic and oncologic diseases. According to studies, pediatric oncology patients account for approximately 25% of all inpatient pediatric transfusions in clinical practice. Pediatric oncology patients may require multiple transfusions of blood components, including red cells, platelets, and plasma, due to underlying disease, bone marrow suppression, and therapy-related bleeding. There are few studies that specifically address transfusion in the pediatric oncology patient population. Recently, some recommendation papers or guidelines have been adopted in the literature.

In children with oncologic diagnoses or in patients undergoing hematopoietic stem cell transplantation who are critically ill or at risk of critical illness and who are hemodynamically stable, an Hb concentration of 7 to 8 g/dL is suggested as a threshold for red blood cell transfusion. For platelet transfusions, both the ICTMG and ASCO advocate a threshold of 10 × 109/L for prophylactic platelet transfusion, and children undergoing hematopoietic stem cell transplantation for sickle cell disease are at high risk for intracranial hemorrhage, so the platelet count should be at least 50 × 109/L in the period immediately after transplantation. There are no specific data for plasma transfusions in oncologic patients, and standard indications established for critically ill children are used in clinical practice. More limited to children with hematologic and oncologic disease, granulocyte transfusions may be considered in children with an absolute neutrophil count less than 500/mL or known neutrophil dysfunction and invasive clinical infection with demonstrated inadequate response to antimicrobial therapy.

In addition to selecting the type, timing, and dosage of blood product, the decision for leukoreduction, irradiation and washing is critical in pediatric oncology patients.

Further research surrounding indications, risk, benefits, and alternatives to RBC transfusion in critically ill children with oncologic diagnoses or undergoing hematopoietic stem cell transplant is sorely lacking. Although strong evidence-based guidelines for this patient population do not exist, given the morbidities associated with the receipt of blood products, practitioners should attempt to use restrictive transfusion strategies.