Red blood cell transfusion in paediatric critical care

Area of Science:

• Pediatric Intensive Care
• Hematology
• Critical Care Medicine

Background:

• Critically ill children often receive red blood cell (RBC) transfusions.
• Transfusions are based on the assumption that increased hemoglobin improves oxygen delivery and utilization.
• The association between anemia and adverse outcomes in critically ill children is complex.

Purpose of the Study:

• To review the current literature on red blood cell transfusions in critically ill children.
• To discuss the potential harms and benefits of RBC transfusions.
• To explore pathophysiological mechanisms related to anemia and transfusion in the pediatric intensive care unit (PICU).

Main Methods:

• This is a narrative review.
• Literature search on RBC transfusions in critically ill children.
• Discussion of existing data and studies, including the TRIPICU study.

Main Results:

• The TRIPICU study demonstrated the safety of withholding transfusions in stable critically ill children until hemoglobin levels fall below 7 g/dL.
• Current data suggest that RBC transfusions in critically ill children are not without risk.
• Increased morbidity and mortality have been associated with common transfusion practices.

Conclusions:

• Physicians should reconsider the routine practice of RBC transfusions in critically ill children.
• Anemia management in the PICU requires careful consideration of risks versus benefits.
• Evidence supports a more conservative approach to RBC transfusion in stable pediatric patients.