Pediatric transfusion practices beyond critical care: Evidence for the need of standardized guidelines and patient blood management

Transfusion therapy remains an essential component of pediatric care. However, significant variability exists in clinical indications and thresholds across disciplines, and standardized guidelines for pediatric transfusion practices remain limited outside of intensive care and hematology-oncology settings.

We conducted a retrospective review of pediatric patients (0-18 years) who received red blood cell (RBC), platelet concentrate (PC), or fresh frozen plasma (FFP) transfusions at a tertiary university hospital between February 2018 and January 2020. Patients in intensive care units and hematology-oncology clinics were excluded. Demographic data, clinical diagnoses, transfusion indications, and pre-transfusion laboratory values were analyzed.

A total of 454 patients underwent 922 transfusion episodes: 61.7% with RBC, 33.1% with FFP, and 5.2% with PC. Surgical patients accounted for 68% of transfusions, with congenital cardiac anomalies (23.3%), orthopedic conditions (20.5%), and trauma (16.7%) as leading indications. Pre-transfusion hemoglobin levels were significantly higher in surgical (mean: 8.3 g/dL) than in medical clinics (mean: 7.2 g/dL, p < 0.001). Similar trends were observed for platelet and coagulation thresholds. FFP use was highest among cardiac surgery, neurometabolic, and chronic inflammatory conditions.

Transfusion thresholds and practices differ across disciplines and, in some settings, appear higher than contemporary restrictive recommendations. Surgical units demonstrated a tendency to transfuse at higher threshold levels, potentially influenced by intraoperative decisions. These findings demonstrate inter-disciplinary variability and support the need for more standardized, Patient Blood Management-guided transfusion practices in pediatric care.