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Red blood cell transfusion: decision making in pediatric intensive care units

Jacques Lacroix1, Pierre Demaret, Marisa Tucci

  • 1Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Quebec, Canada. jacques_lacroix@ssss.gouv.qc.ca

Seminars in Perinatology
|July 24, 2012
PubMed

Insights

Red blood cell transfusions are not necessary for stable pediatric intensive care unit patients with hemoglobin >7 g/dL. This guideline applies to various critical conditions, but triggers for unstable patients require further study.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Transfusion Medicine

Background:

  • Current transfusion guidelines for pediatric intensive care unit (PICU) patients lack specific evidence for stable or stabilized children.
  • Hemorrhagic shock is a clear indication for blood transfusion, but criteria for unstable PICU patients are not well-defined.

Purpose of the Study:

  • To evaluate the necessity of red blood cell (RBC) transfusions in stable and stabilized pediatric intensive care unit (PICU) patients.
  • To assess the adequacy of a hemoglobin threshold of >7 g/dL for RBC transfusions in diverse pediatric critical care populations.
  • To identify clinical determinants for RBC transfusions in unstable PICU children.

Main Methods:

  • Analysis of data from the Transfusion Requirements in Pediatric Intensive Care Unit (TRICC) study.
  • Subgroup analyses were performed on critically ill children with various conditions including respiratory dysfunction, sepsis, and trauma.
  • Inclusion of data from a small randomized clinical trial on postoperative care for single-ventricle physiology.

Main Results:

  • RBC transfusion is not required for stable or stabilized PICU children with hemoglobin levels >7 g/dL.
  • This >7 g/dL threshold is adequate for stable critically ill children across various subgroups, including those with high illness severity, respiratory dysfunction, sepsis, neurological dysfunction, and severe trauma.
  • The >7 g/dL threshold is also suitable for noncyanotic postoperative patients older than 28 days.
  • A hemoglobin level of 9 g/dL was found to be safe in specific postoperative pediatric cardiac surgery patients.

Conclusions:

  • A hemoglobin threshold of >7 g/dL is a safe and adequate guideline for red blood cell transfusions in stable and stabilized pediatric intensive care unit patients.
  • The established threshold is applicable to a broad range of critically ill pediatric patients, including those with significant comorbidities and post-operative conditions.
  • Further research is needed to define clear clinical determinants for red blood cell transfusions in unstable pediatric intensive care unit patients.

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