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Hemoglobin Threshold for Blood Transfusion in a Pediatric Intensive Care Unit
Madhuradhar Chegondi1, Jun Sasaki1, André Raszynski2
1Division of Critical Care Medicine and Nicklaus Children's Hospital (Formerly Miami Children's Hospital), Miami, FL, USA.
Insights
This study found that the hemoglobin threshold for red blood cell transfusions in critically ill children varies by clinical condition. The overall average threshold was 7.3 g/dL, but higher in unstable patients.
Area of Science:
- Pediatric Intensive Care
- Hematology
- Transfusion Medicine
Background:
- Red blood cell (RBC) transfusions are common in pediatric intensive care units (PICUs).
- Establishing appropriate hemoglobin thresholds for transfusion is crucial for optimizing patient outcomes and resource utilization.
- Clinical conditions significantly influence patient physiology and transfusion needs.
Purpose of the Study:
- To determine the hemoglobin threshold for red cell transfusion in children admitted to a pediatric intensive care unit (PICU).
- To investigate variations in transfusion thresholds based on different clinical conditions.
Main Methods:
- Retrospective chart review of critically ill pediatric patients requiring packed red blood cell (PRBC) transfusions.
- Patients were categorized into four groups: acute blood loss, hematologic, unstable, and stable.
- Comparison of pre-transfusion hemoglobin levels across these groups.
Main Results:
- A total of 571 transfusion episodes in 284 patients were analyzed.
- The mean pre-transfusion hemoglobin threshold was 7.3 ± 1.20 g/dL overall.
- Higher hemoglobin thresholds were observed in patients with acute blood loss and unstable conditions (mean 7.9 g/dL) compared to hematologic and stable groups (mean 7.3 g/dL).
- Mortality rates were higher in transfused children compared to non-transfused children.
Conclusions:
- Hemoglobin transfusion thresholds in PICU patients are condition-dependent.
- The average pre-transfusion hemoglobin level was 7.3 g/dL, with higher thresholds indicated for unstable and acute blood loss patients.
- Further research may be needed to refine transfusion guidelines in pediatric critical care.
Objective:
To evaluate the hemoglobin threshold for red cell transfusion in children admitted to a pediatric intensive care unit (PICU).
Methods:
Retrospective chart review study. Tertiary care PICU. Critically ill pediatric patients requiring blood transfusion. No intervention.
Results:
We analyzed the charts of all children between 1 month and 21 years of age who received packed red blood cell (PRBC) transfusions during a 2-year period. The target patients were identified from our blood bank database. For analysis, the patients were subdivided into four groups: acute blood loss (postsurgically, trauma, or acute gastrointestinal bleeding from other causes), hematologic (hematologic malignancies, bone marrow suppression, hemolytic anemia, or sickle cell disease), unstable (FiO2 > 0.6 and/or on inotropic support), and stable groups. We also compared the pre-transfusion hemoglobin threshold in all unstable patients with that of all stable patients. A total of 571 transfusion episodes in 284 patients were analyzed. 28% (n = 160) of transfusions were administered to patients in the acute blood loss group, 36% (n = 206) to hematologic patients, 17% (n = 99) to unstable patients, and 18% (n = 106) to stable patients. The mean pre-transfusion hemoglobin (± SD) in all children as well as in the acute blood loss, hematologic, unstable and stable groups was 7.3 ± 1.20, 7.83 ± 1.32, 6.97 ± 1.31, 7.96 ± 1.37, 7.31 ± 1.09 g/dl, respectively. The transfusion threshold for acute blood loss and unstable groups was higher compared to hematologic and stable groups (p < 0.001; ANOVA with multiple comparisons). The mean pre-transfusion hemoglobin threshold for stable and unstable patients among all groups was 7.3 ± 1.3 and 7.9 ± 1.3 (p < 0.0001), respectively. The observed mortality rate was higher among children who received transfusion compared to other children admitted to PICU.
Conclusion:
The hemoglobin threshold for transfusion varied according to clinical conditions. Overall, the hemoglobin threshold for transfusion was 7.3 ± 1.20 g/dl.
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