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Blood product transfusion practices in pediatric critically ill patients at a tertiary care hospital, Pakistan
Muhammad Rafique1, Sharmeen Nasir2, Amber Kamran3
1Muhammad Rafique, FCPS Pediatrics. Department of Pediatrics, Dr. RKMP Civil, Hospital Karachi, Dow University of Health Sciences. Karachi, Pakistan.
Insights
Inappropriate blood product transfusions occurred in 13.33% of pediatric intensive care patients. This highlights the need for enhanced healthcare worker education on transfusion guidelines for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Transfusion Medicine
- Healthcare Quality Improvement
Background:
- Blood product transfusions are critical interventions in pediatric intensive care units (PICUs).
- Ensuring appropriate transfusion practices is essential for patient safety and optimal outcomes.
- Variations in transfusion practices can lead to suboptimal care and resource utilization.
Purpose of the Study:
- To determine the frequency of inappropriate blood product transfusions in critically ill pediatric patients.
- To identify specific blood products and indications associated with inappropriate transfusions.
- To provide data for improving transfusion guidelines adherence in pediatric critical care.
Main Methods:
- A descriptive study was conducted from January to December 2020 in a PICU.
- Medical records of 39 pediatric patients (1 month to 12 years) receiving blood products were reviewed.
- Transfusion appropriateness was assessed against standard guidelines and consensus recommendations.
Main Results:
- A total of 135 transfusions were analyzed; 13.33% were deemed inappropriate.
- Fresh Frozen Plasma (FFP) was the most common product (44.4%).
- Common indications for transfusion included INR >2.0 for FFP, hemoglobin 5-7 g/dL for Packed Red Cells, and platelet count <20,000 with bleeding risk.
Conclusions:
- A significant proportion of transfusions in critically ill children may be inappropriate.
- Reinforcing healthcare worker knowledge and displaying transfusion guidelines in PICUs are recommended.
- Further interventions are needed to optimize blood product utilization in pediatric critical care.
Objective:
To determine the frequency of inappropriate blood product transfusions in pediatric critically ill patients.
Methods:
We collected data for this descriptive study from January to December 2020 at the Pediatric Intensive Care Unit (PICU) of Dr. RKMP Civil Hospital, Karachi. We included all patients one month to 12 years of age, admitted to pediatric intensive care unit and received any blood product transfusion. We reviewed their medical records and noted the demographic and clinical variables, type of blood product transfused with its indication and determined whether transfusion was appropriate or not, as per the standard guidelines and consensus recommendations.
Results:
Number of patients who were transfused was n=39, out of which females were 51.3%. Mean age of the patients was 49.0 months ±50.9 months. Total number of transfusions done were n=135, with most common blood product transfused being Fresh Frozen plasma (FFP) in 44.4%. A total of n=117 (86.66%) transfusion were appropriate as per the standard guidelines, while 18 (13.33%) were inappropriate (P-value <0.5). The most common indication of FFP transfusion was INR >2.0 in 51.6%, for Packed red cell transfusion was hemoglobin between 5 and 7 gm/dl in 35.5% and for Platelets was <20,000 with risk of bleeding in 36.6%.
Conclusion:
This study highlights the occurrence of inappropriate transfusions in critically ill pediatric patients. We need to reinforce the knowledge of our health care workers and display the guidelines in intensive care units.
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