Related Experiment Video
Updated: Apr 14, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Clinical Outcomes Associated With RBC Transfusions in Critically Ill Children: A 1-Year Prospective Study
Pierre Demaret1, Marisa Tucci, Oliver Karam
11Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium. 2Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada. 3Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland. 4Department of Social and Preventive Medicine, Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada. 5Department of Pediatrics, Research Center, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada.
Insights
Red blood cell (RBC) transfusions in critically ill children are linked to increased risks of multiple organ dysfunction syndrome, longer mechanical ventilation, and extended PICU stays. Stored RBCs may also impair oxygenation, warranting careful consideration before transfusion.
Area of Science:
- Pediatric critical care medicine
- Transfusion medicine
- Hematology
Background:
- Red blood cell (RBC) transfusions are common in critically ill children.
- The potential complications and benefits of RBC transfusions in this population require thorough investigation.
Purpose of the Study:
- To identify potential complications associated with RBC transfusions in critically ill children admitted to a pediatric intensive care unit (PICU).
Main Methods:
- Prospective observational study conducted in a tertiary children's hospital PICU.
- Data collected from medical charts of consecutively admitted children over a 1-year period.
- Comparison of outcomes between transfused and non-transfused pediatric patients.
Main Results:
- RBC transfusion was associated with a significantly increased risk of new or progressive multiple organ dysfunction syndrome (OR 3.85).
- Transfused children experienced significantly longer mechanical ventilation duration and PICU length of stay.
- A significant reduction in arterial partial pressure of oxygen was observed within 6 hours post-transfusion, and increased renal replacement therapy was noted.
Conclusions:
- RBC transfusions in critically ill children are associated with adverse outcomes, including prolonged ventilation and PICU stay, and increased risk of multiple organ dysfunction syndrome.
- The efficacy of stored RBCs in improving oxygenation in this patient group is questionable.
- Clinicians should carefully weigh the risks and benefits before prescribing RBC transfusions to PICU patients.
Objective:
To identify the potential complications associated with RBC transfusions.
Design:
Prospective observational study.
Setting:
PICU in a tertiary children's hospital.
Patients:
All children consecutively admitted to our PICU during a 1-year period.
Interventions:
None.
Measurements And Main Results:
Data were abstracted from medical charts prospectively. Outcomes possibly attributable to RBC transfusions were looked for daily. In transfused cases, it was considered that an outcome was associated with a transfusion only if it was observed after the first RBC transfusion. During the 1-year study period, 913 consecutive admissions were documented, 842 of which were included. Among them, 144 (17%) were transfused at least once. When comparing transfused cases with nontransfused cases, the odds ratio for new or progressive multiple organ dysfunction syndrome was 5.14 (95% CI, 3.28-8.06; p < 0.001). This association remained statistically significant in the multivariable analysis (odds ratio, 3.85; 95% CI, 2.38-6.24; p < 0.001). Transfused cases were ventilated longer than nontransfused cases (14.1 ± 32.6 vs 4.3 ± 9.6 d, p < 0.001), even after adjustment in a Cox model. The PICU length of stay was significantly increased for transfused cases (12.4 ± 26.2 vs 4.9 ± 10.2 d, p < 0.001), even after controlling for potential confounders. The paired analysis for comparison of pretransfusion and posttransfusion values showed that the arterial partial pressure in oxygen was significantly reduced within the 6 hours after the first RBC transfusion (mean difference, 25.6 torr, 95% CI, 5.7-45.4; p = 0.029). The paired analysis also showed an increased proportion of renal replacement therapy.
Conclusions:
RBC transfusions in critically ill children were associated with prolonged mechanical ventilation and prolonged PICU stay. The risk of new or progressive multiple organ dysfunction syndrome was also increased in some transfused children. Furthermore, our study questions the ability of stored RBCs to improve oxygenation in critically ill children. Practitioners should take into account these data when prescribing an RBC transfusion to PICU patients.
