AI Article Synopsis

  • Bleeding in critically ill pediatric hematology/oncology patients can lead to severe complications, and recombinant activated factor VII (rFVIIa) has shown some benefits in cases where traditional treatments fail.
  • In a study of 39 patients under 21 years old who received rFVIIa while in the ICU, 56% experienced decreased bleeding after treatment, and there was a notable reduction in blood transfusion needs shortly after administration.
  • Despite a positive response in some patients, overall mortality was high at 37.5%, particularly among those with pulmonary hemorrhages, underscoring the urgent need for further research to enhance treatment strategies in this vulnerable group.

Article Abstract

: Bleeding among critically ill paediatric haematology/oncology (CIPHO) patients leads to significant morbidity and mortality. Recombinant activated factor VII (rFVIIa) has shown some benefits in previous reported off-label use when conventional therapies have failed. However, data in CIPHO are lacking. We retrospectively studied (2006-2014) the efficacy and outcomes in CIPHO patients younger than 21 years who received at least one rFVIIa dose for bleeding in the ICU. Of 39 patients, the majority had leukaemia (59%), bone marrow transplantation (77%) and a life-threatening bleed (80%) with most common site being pulmonary haemorrhage (44%). Most needed invasive mechanical ventilation (87%) or vasopressor support (59%). After rFVIIa administration, 56% had cessation or decreased bleeding. Packed red blood cell transfusion requirements decreased significantly 48-72 h after rFVIIa administration. Lower baseline prothrombin time and more rFVIIa doses were related to bleeding control. A favourable response was associated with higher survival (55% in responders versus 18% in nonresponders, P = 0.019). Overall, bleeding-related mortality was 37.5%, highest in pulmonary haemorrhage. Two patients had thromboembolic events. Use of rFVIIa for CIPHO patients appears to be well tolerated with low adverse events. Despite half of the patients having a favourable response of cessation or decrease in bleeding after rFVIIa administration, mortality was high. These findings highlight the need for prospective studies to evaluate interventions to improve outcomes in this population.

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Source
http://dx.doi.org/10.1097/MBC.0000000000000942DOI Listing

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