Evaluation of a pediatric patient blood management program: A pre-/post-study

Red blood cell (RBC) transfusions are important interventions for anemia or blood loss but are accompanied by the risk of transfusion-associated adverse events (TAEEs). Patient blood management (PBM) offers a system-level, multidisciplinary approach to optimize transfusions through a variety of interventions. The impact of PBM in a pediatric hospital system is unclear, and this study sought to evaluate the impact of a PBM program before and after implementation in a large pediatric academic medical center.

A retrospective cohort design was used to evaluate the impact of a PBM program in the year before implementation (2015) and after (2019). Children between 4 months and under 18 years at the time of admission were included, and clinical and demographic data were queried from the electronic health record. Transfusion utilization, RBC guideline adherence, and TAEEs were compared before and after the program was implemented.

In the pre- and post-intervention years, a total of 35,245 hospitalizations were evaluated, with increasing patient volumes and complexity noted in the post-intervention year. The post-intervention year had fewer hospitalizations with a transfusion ordered during the stay (p = 0.02), lower pre-transfusion hemoglobin values (p < 0.01), and smaller volumes of RBC transfusions ordered (p < 0.01). No statistically significant difference in incidence of TAEEs was noted.

This study suggests that PBM may be effective in reducing exposure to transfusion and related risks to hospitalized children. Future studies are needed to evaluate PBM programs and their cost-effectiveness in pediatric populations.