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Updated: Mar 14, 2026
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Hematocrit Levels, Blood Testing, and Blood Transfusion in Infants After Heart Surgery
Claudia Delgado-Corcoran1, Katherine H Wolpert, Kathryn Lucas
11Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.2Division of Pediatric Critical Care Medicine, Primary Children's Hospital, Intermountain Health Care, Salt Lake City, UT.
Insights
Judicious blood testing in infants after heart surgery reduced lab tests but did not significantly decrease red blood cell (RBC) transfusions. This quality improvement targeted testing, showing potential for optimizing transfusion practices in pediatric cardiac intensive care units.
Area of Science:
- Pediatric Cardiac Surgery
- Intensive Care Medicine
- Transfusion Medicine
Background:
- Postoperative transfusions are common in infants following complex heart surgery.
- Optimizing laboratory testing protocols may influence transfusion rates and patient outcomes.
Purpose of the Study:
- To evaluate the impact of a quality improvement initiative aimed at reducing routine laboratory testing on packed red blood cell (RBC) transfusions in infants after heart surgery.
Main Methods:
- A retrospective study compared infants before and after the implementation of a new quality improvement process designed to decrease routine laboratory testing.
- Patient groups were stratified by single versus biventricular physiology.
- Key outcomes included laboratory test frequency, transfusion rates, time to first transfusion, and hematocrit levels.
Main Results:
- The quality improvement process significantly reduced laboratory tests per patient per day in both single and biventricular physiology groups.
- There was no statistically significant difference in the proportion of infants receiving transfusions between pre- and post-intervention groups.
- Time to first transfusion was significantly longer in the post-intervention single ventricle group, and the median hematocrit at first transfusion was lower in the cyanotic post-intervention population.
Conclusions:
- Targeted blood testing in infants undergoing heart surgery effectively reduced the number of laboratory tests performed.
- The implemented strategy did not lead to a significant reduction in the overall amount or proportion of packed RBC transfusions.
- Further research may be needed to refine strategies for optimizing transfusion practices in this vulnerable population.
Objective:
To determine whether judicious blood testing impacts timing or amount of packed RBC transfusions in infants after heart surgery.
Design:
A retrospective study comparing before and after initiation of a quality improvement process.
Setting:
A university-affiliated cardiac ICU at a tertiary care children's hospital.
Patients:
Infants less than 1 year old with Risk Adjustment for Congenital Heart Surgery category 4, 5, 6, or d-transposition of great arteries (Risk Adjustment for Congenital Heart Surgery 3) consecutively treated during 2010 through 2013.
Intervention:
A quality improvement process implemented in 2011 to decrease routine laboratory testing after surgery.
Measurements And Main Results:
Fifty-two infants preintervention and 214 postintervention had similar age, weight, proportion of cyanotic lesions, and surgical complexity. Infants with single versus biventricular physiology were compared separately. The number of laboratory tests per patient adjusted for cardiac ICU length of stay (laboratory tests/patient/day) was significantly lower in postintervention populations for single and biventricular groups (9 vs 15 and 10 vs 15, respectively; p < 0.001). The proportion of single ventricle patients transfused post- and preintervention was not statistically different (72% vs 90%; p = 0.130). Transfusion in the biventricular groups was the same over time (65% vs 65%). Time to first transfusion was significantly longer in the postintervention single ventricle group (4 vs 1 d; p < 0.001), and was not statistically different in the biventricular patients (4 vs 7 d; p = 0.058). The median hematocrit level at first transfusion was significantly lower (37% vs 40%; p = 0.004) postintervention in the cyanotic population, but did not differ in the biventricular group (31% vs 31%; p = 0.840).
Conclusion:
In infants after heart surgery, blood testing targeted to individual needs significantly decreased the number of blood tests, but did not significantly decrease postoperative blood transfusion.
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