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Red Cell Transfusion During Pediatric Intensive Care: A 28-Day Point Prevalence Study in Three European Countries in
Laura Butragueño-Laiseca1,2,3,4, Samiran Ray5, Avishay Sarfatti6
1Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Insights
In European pediatric intensive care units (PICUs), 12.8% of children received red blood cell (RBC) transfusions, primarily based on hemoglobin levels rather than clinical triggers. This highlights variability in transfusion practices and potential areas for optimization.
Area of Science:
- Pediatric critical care medicine
- Transfusion medicine
- Hematology
Background:
- Red blood cell (RBC) transfusions are common in pediatric intensive care units (PICUs).
- Practices regarding transfusion triggers, particularly hemoglobin thresholds, can vary significantly.
- Optimizing RBC transfusion protocols is crucial for patient outcomes.
Purpose of the Study:
- To determine the prevalence of RBC transfusion in critically ill children across three European countries.
- To analyze the hemoglobin thresholds, clinical triggers, and outcomes associated with RBC transfusions in PICU patients.
- To identify potential areas for improving transfusion strategies in pediatric critical care.
Main Methods:
- An international 4-week point prevalence study conducted in 2023.
- Data collected from 44 PICUs in Spain, the United Kingdom, and Italy.
- Inclusion criteria: PICU patients aged 1 month to 17 years receiving RBC transfusion.
Main Results:
- 12.8% of 2713 pediatric patients received at least one RBC transfusion.
- Hemoglobin level was the primary indication for transfusion (54.6%), often exceeding 7.0 g/dL.
- Median hemoglobin levels before transfusion varied significantly by country (7.8-8.9 g/dL), with limited use of other clinical triggers.
Conclusions:
- RBC transfusion is prevalent in European PICUs, with hemoglobin levels frequently driving transfusion decisions.
- Current transfusion practices often exceed recommended thresholds and rarely consider other clinical triggers.
- Standardizing hemoglobin thresholds and adopting goal-directed strategies could optimize RBC transfusion practices in critically ill children.
Objectives:
To describe the prevalence of RBC transfusion in children admitted to PICUs in three European countries and to determine hemoglobin threshold, triggers, and outcomes for transfusions.
Design:
International 4-week point prevalence study in 2023.
Setting:
Forty-four PICUs across Spain, the United Kingdom, and Italy.
Patients:
PICU patients 1 month to 17 years old receiving RBC transfusion.
Interventions:
None.
Measurements And Main Results:
During four prespecified 7-day blocks (from March 2023 to July 2023), 348 of 2713 patients (12.8%) received at least one RBC transfusion, accounting for 527 transfusions. The proportion of patients receiving RBC transfusion in Italy, the United Kingdom, and Spain was 17.3% (66/382), 13.9% (166/1195), and 10.2% (116/1136), respectively. The primary indication for transfusion in the 527 transfusion events was hemoglobin level (54.6%), followed by bleeding (10.6%), cardiovascular instability (10.5%), and extracorporeal support (10.1%). In 45.1% of RBC transfusions, there was no other physiologic trigger apart from hemoglobin. The median (interquartile range [IQR]) hemoglobin level before transfusion was 8.3 g/dL (IQR, 7.2-9.9 g/dL), with median values varying significantly among Spain, the United Kingdom, and Italy, respectively, 7.8 vs. 8.6 vs. 8.9 g/dL ( p < 0.001). When excluding cardiac patients, overall median hemoglobin threshold was 7.4 g/dL (IQR, 6.8-8.6 g/dL) and was comparable across the three countries ( p > 0.05). The overall 28-day PICU mortality in 348 patients receiving transfusions was 10.7%. The number of transfusions was associated with mortality, even after adjusting for reason for admission and admission Pediatric Index of Mortality score.
Conclusions:
In 44 European PICUs in 28 days during 2023, 12.8% of critically ill children received one or more RBC transfusions during their PICU stay. Hemoglobin level was the primary determinant for transfusion, often exceeding the recommended 7.0 g/dL threshold. Other clinical triggers are rarely considered. Defining hemoglobin thresholds and adopting a goal-directed transfusion strategies may optimize clinical transfusion practices.
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