Related Experiment Video
Updated: Jul 14, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Red blood cell transfusion in critically ill children is independently associated with increased mortality
Martin C J Kneyber1, Mohammed I Hersi, Jos W R Twisk
1Department of Pediatric Intensive Care, Office 8 D 12, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. m.kneyber@vumc.nl
Insights
Red blood cell (RBC) transfusions in critically ill children are linked to higher mortality and longer hospital stays. This association remains significant even after accounting for other risk factors, highlighting potential risks of transfusion in this vulnerable population.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Epidemiology
Background:
- Red blood cell (RBC) transfusion is a common intervention in critically ill children.
- The independent association between RBC transfusion and outcomes in this population requires further investigation.
Purpose of the Study:
- To determine if RBC transfusion is independently associated with increased mortality and morbidity in critically ill children.
Main Methods:
- Retrospective, descriptive epidemiologic cohort study.
- Inclusion criteria: Critically ill children (0-18 years) without active blood loss, excluding specific groups (preterm infants, post-cardiothoracic surgery, chronic anemia).
- Data analysis included multivariate regression to adjust for confounding factors.
Main Results:
- A total of 295 patients were studied; 22.7% received RBC transfusions.
- Transfused patients exhibited significantly higher mortality (16.4% vs. 2.6%, p < 0.001).
- RBC transfusion was independently associated with increased mortality, prolonged mechanical ventilation, vasoactive agent use, and PICU stay.
Conclusions:
- RBC transfusion in critically ill children is an independent risk factor for adverse outcomes.
- Findings suggest a need for careful consideration of transfusion thresholds and potential risks in pediatric intensive care.
Objective:
To test the hypothesis that RBC transfusion in critically ill children is independently associated with increased mortality and morbidity.
Design:
Retrospective, descriptive epidemiologic cohort study.
Setting:
Single-center experience of a nine-bed pediatric intensive care unit (PICU) facility.
Patients:
Critically ill children without ongoing active blood loss aged 0[Symbol: see text]months to 18[Symbol: see text]years, excluding prematurely born infants or patients after cardiothoracic surgery, and patients with chronic anemia.
Interventions:
None.
Measurements And Results:
Data of 295 consecutive patients was studied. Of these patients, 13.4% had a Hb concentration less than 9.6 g/dl. Sixty-seven (22.7%) of all patients were transfused, 39 only once. Transfused patients had a higher mortality (16.4 vs. 2.6%, p < 0.001). Mortality seemed related to the number of transfusion (p = 0.002) rather than the pre-transfusion Hb concentration (p = 0.10). Transfused patients required prolonged ventilatory support (11.1 +/- 1.8 vs. +/- 0.3 days, p < 0.001), infusion of vaso-active agents (8.2 +/- 1.8 vs. 2.8 +/- 0.6 days, p < 0.001) and PICU stay (13.0 +/- 1.8 vs. 3.2 +/- 0.2 days, p < 0.001). After multivariate analysis adjusting for age, PIM probability of death, mean TISS-28 score during the first 48 h, post-operative admission, diagnosis of sepsis or trauma or malignancy, pre-transfusion Hb concentration, and RBC transfusion remained independently associated with mortality and morbidity.
Conclusions:
RBC transfusion in critically ill children is independently associated with increased mortality and prolonged duration of mechanical ventilation, prolonged infusion of vaso-active agents and prolonged PICU stay.
Related Concept Videos
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy the...
01:24Factors Affecting Erythropoiesis
Several factors influence the erythrocyte production rate, with tissue oxygen level being among the most critical. Intense exercise or high altitudes can cause tissue hypoxia, which triggers the kidneys to release more erythropoietin (EPO) into the bloodstream.
EPO then...
01:27Disorders of Erythrocytes
Erythrocyte disorders can be broadly categorized into two main types: anemic and polycythemic conditions.
A low oxygen-carrying capacity of the blood due to the loss, lower production, or destruction of erythrocytes is termed anemia. Hemorrhagic anemia, for example, occurs when bleeding from an external wound or internal ulcer reduces erythrocyte counts.
On the other...