Işık Odaman Al

Objective: Blood and blood components are valuable therapeutic products, particularly in pediatric settings where transfusion demand is variable and often urgent. Minimizing blood product wastage is essential to protect limited resources and ensure patient safety. The aim was to determine the rate, causes, and clinical distribution of blood product wastage in a tertiary pediatric hospital over a 1-year period. Methods: This retrospective descriptive study reviewed all red blood cell concentrates (RBCC), apheresis platelet concentrates (APC), fresh frozen plasma (FFP), and cryoprecipitate processed in 2018. Wastage was defined as any allocated but unused unit that became unsuitable for transfusion. Reasons for discard and requesting clinical departments were analyzed. Results: A total of 9 750 components were prepared; 73 (0.75%) were discarded. The wastage rates were RBCC 0.38%, APC 0.54%, FFP 1.8%, and cryoprecipitate 0.6%. The leading discard cause was expiration of shelf life (44%), followed by inappropriate requests (7%) and technical issues such as leakage or hemolysis (6%). Intensive care and emergency units accounted for the highest proportion of wastage. Conclusion: Although the overall wastage rate was low, most losses were preventable. Implementing real-time electronic inventory tools, clinician education, and improved ordering–transfusion synchronization may further reduce wastage and enhance transfusion safety in pediatric care. Cite this article as: Tahta N, Oymak Y, Ayhan FY, et al. Evaluation of blood product wastage rates and causes. Cerrahpaşa Med J 2026, 50, 0087, doi: 10.5152/cjm.2026.25087.

Objectives: Secondary hemophagocytic lymphohistiocytosis (sHLH) is a severe hyperinflammatory syndrome requiring rapid recognition and treatment. Despite the expanding availability of biologic and cytokine‐directed therapies, etoposide‐based immunochemotherapy remains the primary treatment in many pediatric centers. This study evaluated the efficacy, response kinetics, and clinical outcomes of etoposide‐based therapy in children with sHLH. Methods: We retrospectively analyzed 32 pediatric patients diagnosed with sHLH between 2018 and 2023 at a tertiary center. Diagnosis was based on HLH‐2004 criteria; primary HLH was excluded through genetic testing when available. All patients received dexamethasone and etoposide, with cyclosporine A initiated after Week 1. Trigger‐directed therapies included rituximab for EBV‐HLH and anakinra or tocilizumab in selected hyperinflammatory states. Laboratory dynamics (ferritin, fibrinogen, platelets, and absolute neutrophil count), clinical responses, relapse, hematopoietic stem cell transplantation (HSCT), and overall survival (OS) were assessed. Results: The median age was 38 months; 62.5% were male. Triggers included EBV (34%), other viral infections (19%), rheumatologic disease/MAS (16%), bacterial infection (13%), and malignancy (9%). By Week 4, ferritin decreased from 6480 to 1240 ng/mL and fibrinogen increased from 122 to 286 mg/dL ( p < 0.001). Fever resolved in 90% by Week 2, and 81% achieved complete laboratory response. During a median follow‐up of 18 months, relapse occurred in 18.8% and HSCT was required in 15.6% of patients. Overall survival was 91% at 1 year and 86% at 2 years. Adverse events were consistent with expected etoposide‐related toxicities. Conclusion: Etoposide‐based immunochemotherapy provided rapid disease control and favorable survival in pediatric sHLH. These findings support the continued relevance of etoposide while underscoring the need for risk‐adapted approaches integrating trigger‐directed therapy, cytokine inhibitors, and timely HSCT in selected patients.

Introduction: Ewing sarcoma (ES) is an aggressive pediatric bone and soft tissue malignancy. Despite advances in multimodal therapy, outcomes remain suboptimal for patients with high-risk features such as large tumor volume, poor histologic response, disseminated disease, or relapse. Maintenance strategies have gained interest in pediatric sarcomas, but evidence in ES is limited. Pazopanib, an oral multi-targeted tyrosine kinase inhibitor, has shown activity in adult soft tissue sarcomas; however, data on its use as maintenance therapy in pediatric ES are scarce. Methods: We retrospectively analyzed six pediatric ES patients who received pazopanib as maintenance therapy following consolidation treatment or, when applicable, after high-dose chemotherapy with autologous stem cell transplantation. Indications included poor-risk localized disease, relapse, or stable residual disease after frontline therapy. Pazopanib dosing, duration, toxicity, and clinical outcomes were reviewed. Results: Pazopanib was administered at doses of 400–800 mg in five patients and 200 mg twice daily in one patient. Hair depigmentation occurred in all patients, and one patient developed reversible hepatotoxicity requiring temporary interruption and dose reduction. At a median follow-up of 47 months (range, 18–53 months), five patients remained in complete remission. One patient with disseminated disease at diagnosis developed intracranial relapse 18 months post-transplant while still receiving pazopanib. Conclusions: In this retrospective cohort, pazopanib was generally well tolerated and may have a potential role as maintenance therapy in selected high-risk pediatric ES patients. However, efficacy cannot be determined from this limited series, and prospective studies are needed to better define its clinical utility in ES.

Introduction: Thrombocytopenia is a common clinical problem in cancer patients undergoing high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT). It can occur as prolonged isolated thrombocytopenia (PIT) or secondary failure of platelet recovery (SFPR) and may cause potentially fatal bleeding. However, data on the treatment of post-transplant thrombocytopenia is still lacking. Methods: We reported our practices involving 15 pediatric patients who received eltrombopag (ELT) treatment for PIT and SFPR after autologous HSCT. Results: The overall response was 78.5% (11/14), with 1 patient excluded due to noncompliance. The 12 surviving patients' median follow up was 699 days (range: 167 to 2250 d). Conclusions: Our study indicates the efficacy and safety of ELT for treating PIT and SFPR after autologous HSCT in pediatric patients. However, more studies are needed to confirm these findings in children.

Objective: Patients with Noonan syndrome (NS), who may need various surgical interventions throughout their lives, need to be evaluated carefully in the preoperative period due to the risk of bleeding diathesis. There is a limited number of studies evaluating bleeding diathesis in patients with NS. In this study, we aimed to determine the frequency of bleeding diathesis in patients with NS and to evaluate the place of thromboelastography (TEG) in determining the risk of bleeding. Method: In our study, bleeding score and coagulation test results obtained from the files of 12 patients with NS were evaluated. Results: The most frequently detected factor deficiency is vWF deficiency (41%), followed by platelet dysfunction (33%). Two cases with a bleeding score of 2 or above were detected, and in one of them, both platelet dysfunction (response to epinephrine in platelet aggregometer, 7%) and vWF deficiency (vWF Ag: 20%), and in the other case, mild Factor VII deficiency (17%) were detected. TEG results of nine patients were normal. TEG abnormality was detected in three patients and 2 of them had bleeding phenotype. Conclusion: As a result, although laboratory examinations in patients with NS often yield values consistent with bleeding diathesis, bleeding event does not occur in most patients. We suggest that with the use of the TEG method, the risk of bleeding can be predicted and unnecessary treatments can be prevented.

Background: Respiratory system involvement is common in congenital plasminogen deficiency. Although many treatment approaches have been tried, there is still no definitive treatment for respiratory system involvement. Observation(s): We report 2 congenital plasminogen deficiency cases, who presented with severe respiratory symptoms, for whom a novel treatment modality was tried. After intravenous administration of FFP (fresh frozen plasma), tissue plasminogen activator and FFP were administered intratracheally, and respiratory system findings improved. Conclusions: Intratracheal administration of tissue plasminogen activator and FFP is an available treatment modality for patients with lung involvement. Fibrin plaques should be carefully removed and new lesion formation should be prevented.

Background: Data on the outcome and risk factors of pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. Objectives: We aimed to describe risk factors for a severe course and mortality. Method: In this nationwide study, data were collected retrospectively from 28 transplant centers. Results: One hundred ninety-six children [(63.8% male; median age 8.75 (IQR, 4.86-14.30)] who received allogeneic (n: 184, 93.9%) or autologous (n: 12, 6.1%) HSCT were included. The median time from HSCT to SARS-CoV-2 infection was 207.5 days (IQR, 110.2-207.5). The most common clinical manifestation was fever (58.2%), followed by cough (33.7%); 43 cases (21.9%) were asymptomatic. Lower respiratory tract disease (LRTD) and multisystem inflammatory syndrome in children (MIS-C) developed in 58 (29.6%) and 8 (4.1%) patients, respectively. Twenty-six patients (13.3%) required ICU admission. Nine patients died at a median of 17 days (min-max 1-33) after COVID-19 diagnosis, 6 of whom died due to the disease, with a COVID-19 lethality rate of 3.1%. The 6-week overall survival was 95.4% (95% CI 92.5-98.3). Multivariate analysis found that HSCT with a mismatched donor (OR, 8.98, p: 0.039) and LRTD (OR, 61.55, p: 0.001) were independent risk factors for ICU admission; MIS-C (OR, 9.55, p: 0.044) and lymphopenia (OR, 4.01, p: 0.030) at diagnosis were risk factors for mortality. Conclusion: Overall mortality was lower in children than in adult counterparts, and HSCT with a mismatched donor, lymphopenia, LRTD, MIS-C and ICU admission were important risk factors for adverse outcomes.

Introduction: Asparaginase is an indispensable drug in treating childhood acute lymphoblastic leukemia (ALL). Hypersensitivity reactions (HSR) are the most common side effects and interfere with the antineoplastic activity of the drug. This study aims to compare the intramuscular (IM) and intravenous (IV) administration routes of Native Escherichia coli Lasparaginase (L-ASNase) in terms of hypersensitive reactions. Methods: L-ASNase was randomly administered IV or IM to newly diagnosed ALL patients and HSR was monitored in all patients for 1 h following the end of the IV infusion and for 2 h following the end of the IM administration of L-ASNase. Based on a retrospective review of clinical charts, reactions were identified. In order to determine the severity of each allergic reaction, we used the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 for allergic reactions. Results: A total of 1032 doses of L-ASNase were administered to 85 patients (42 males and 43 females) during the study period. Among 85 patients, 30 reactions were recorded, which means that 35% of the patients reacted. According to the CTCAE, twenty-nine out of 30 reactions (97%) were grade 2, while one (3%) was grade 4. In terms of individual doses, there was a non-significant trend toward increased incidence of reactions with IV administration (3.8% versus 0.9%, p = 0.064). The rate of reactions was higher in patients who received all IV doses ( n: 60) as compared to those who received all IM doses ( n: 25) (31.7% vs. 3.5%; chi-square= 8.415, p value=0.04). Based on the risk groups and HSR incidence, it was found that high risk group (HRG) patients were significantly more likely to develop HSR compared to the standart risk group (SRG) and intermediate risk group (MRG) patients (chi-square p = 0.003, CI: 95%; odds ratio: 3.12 and 5.91, respectively). Conclusions: In conclusion, IM administration of L-ASNase causes significantly less HSR to L-ASNase than the IV route. Patients with HRGALL have a higher risk of HSR. Since L-ASNase is still used in many developing countries and there are problems in the supply of Erwinia chrysanthemi ASNase (Erwinia), LASNase can be administered IM to reduce the frequency of HSR.