Determinants of red blood cell transfusions in a pediatric critical care unit: A prospective, descriptive epidemiological study*

Abstract

A significant proportion of critically ill children receive at least one red blood cell transfusion during their PICU stay. Presence of anemia, cardiac disease, severe critical illness, and multiple organ dysfunction syndrome are the most significant determinants of red blood cell transfusions in PICU.

Red blood cell transfusion in critically ill children is independently associated with increased mortality

“…However, our study was methodologically different compared with the study by Goodman et al [4]. Because patients with a pre-transfusion Hb greater than 9 g/dl are also (often) transfused, we included all patients irrespective of the pre-transfusion Hb value [3,17]. With this inclusion method we not only support the observations by Goodman et al [4] but also observed an even stronger association, adding more strength to our study.…”

“…In our study we found that 13.4% of the patients had a Hb below 9.7 g/dl. Also, our transfusion rate is in accordance with previously reported numbers by others [3]. Based upon this study we advocate further investigations aimed at defining a suitable and safe threshold value for Hb used in the decision as to when to transfuse a critically ill child, stratifying for age, disease severity, and co-morbidities.…”

“…From two surveys among pediatric intensivists comprising four scenarios from daily clinical practice, it became clear that there is a striking variation in Hb threshold to transfuse patients, especially among children after cardiac surgery or children with sepsis [2,17]. This was confirmed by a prospective, descriptive single-center study demonstrating that cardiac disease, severe critical illness defined by admission PRISM score > 10, and multiple organ dysfunction syndrome (MODS) were independent determinants for the decision to transfuse critically ill children [3].…”

“…The practice of red blood cell (RBC) transfusion in critically ill children is common [1][2][3]. From a retrospective survey among five pediatric intensive care units (PICU) in the United States it was found that 54.5% of all children with a pre-transfusion hemoglobin (Hb) concentration below 9 g/dl received one or more RBC transfusions [4].…”

Are red blood cell transfusions associated with nosocomial infections in critically ill children?

“…RBCTs have been recognized to pose risks associated with storage and in relation to the immunomodulatory effects that occur in almost all recipients; this underlines a possible association between RBCT and higher mortality and nosocomial infection rates. [2][3][4] Recognizing these risks has resulted in a more critical approach to the benefits associated with RBCT. The underlying mechanisms of immune response modulation by RBCT may include biological response modifiers of white blood cells, impaired T cell and natural killer cell activity, and defects in antigen presentation.…”