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Perioperative Transfusions and Venous Thromboembolism

Ruchika Goel1,2, Cassandra D Josephson3,4, Eshan U Patel1

  • 1Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland.

Pediatrics
|March 22, 2020
PubMed

Insights

Perioperative red blood cell (RBC) transfusions increase the risk of venous thromboembolism (VTE) in hospitalized children, infants, and neonates. This association is dose-dependent in children, highlighting the need for careful transfusion decisions.

Area of Science:

  • Pediatric Hematology
  • Pediatric Critical Care
  • Surgical Outcomes

Background:

  • The incidence of venous thromboembolism (VTE) in hospitalized children is increasing.
  • Red blood cells (RBCs) are implicated in the development of pathological thrombosis.
  • The association between perioperative RBC transfusion and postoperative VTE in pediatric patients requires further investigation.

Purpose of the Study:

  • To examine the association between perioperative RBC transfusion and postoperative VTE in pediatric patients.
  • To stratify the analysis by age groups: neonates, infants, and children.
  • To investigate the dose-dependent relationship between RBC transfusion volume and VTE in children.

Main Methods:

  • Utilized data from the American College of Surgeons' National Surgical Quality Improvement Project pediatric databases (2012-2017).
  • Employed multivariable logistic regression to analyze the association between perioperative RBC transfusion and VTE development within 30 days of surgery.
  • Stratified analyses were performed for neonates (≤28 days), infants (>28 days to <1 year), and children (≥1 year).

Main Results:

  • Included 20,492 neonates, 79,744 infants, and 382,862 children.
  • Postoperative VTE occurred in 0.48% of neonates, 0.2% of infants, and 0.1% of children.
  • Perioperative RBC transfusion was significantly associated with increased VTE risk across all age groups (neonates: aOR=4.1; infants: aOR=2.4; children: aOR=2.2).
  • In children, higher volumes of RBCs transfused were linked to a dose-dependent increase in VTE risk.

Conclusions:

  • Perioperative RBC transfusions are an independent risk factor for postoperative VTE in neonates, infants, and children.
  • The findings suggest a dose-dependent relationship between RBC transfusion volume and VTE risk in children.
  • Further prospective studies are needed to validate these findings and inform evidence-based transfusion guidelines in pediatric surgery.
Abstract

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