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Critically ill children: to transfuse or not to transfuse packed red blood cells, that is the question

Cornelius T Tyrrell1, Scot T Bateman

  • 1University of Massachusetts Medical School, Worcester, MA, USA. Cornelius.tyrrell@UMassMemorial.org

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 19, 2011
PubMed

Insights

Packed red blood cell transfusions are common in pediatric intensive care units, but new data suggest a hemoglobin threshold of >7 g/dL offers no benefit and may increase risks. Evidence-based decisions are crucial.

Area of Science:

  • Pediatric Critical Care Medicine
  • Transfusion Medicine
  • Hematology

Background:

  • Packed red blood cell (PRBC) transfusions are frequently administered in pediatric intensive care units (PICUs).
  • Historically, limited data guided PRBC transfusion practices in critically ill children.
  • Adult critical care studies suggest potential negative outcomes associated with PRBC transfusions.

Purpose of the Study:

  • To summarize current evidence on PRBC transfusion in the PICU.
  • To inform evidence-based decision-making for PRBC transfusions in pediatric patients.
  • To address the growing concerns regarding PRBC transfusion risks in critically ill children.

Main Methods:

  • Comprehensive literature review.
  • Inclusion of studies from PubMed and relevant article citations.
  • Consideration of adult critical care literature on PRBC transfusions.

Main Results:

  • Recent data indicate no improved outcomes with a hemoglobin transfusion threshold greater than 7 g/dL.
  • Smaller studies suggest potential increased morbidity and mortality in PICU patients receiving PRBC transfusions.
  • The practice of PRBC transfusion in PICUs warrants careful reconsideration based on emerging evidence.

Conclusions:

  • PRBC transfusion is prevalent in PICUs, but practice has lacked robust data.
  • Evidence suggests that higher hemoglobin thresholds do not improve outcomes and may be harmful.
  • PICU patients may face increased risks, necessitating a critical evaluation of transfusion protocols.
Abstract

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