Patterns and Predictors of Red Blood Cell Transfusion in the Pediatric Intensive Care Unit: A Retrospective Cohort...

To evaluate red blood cell (RBC) transfusion practices in a pediatric intensive care unit (PICU) and identify factors predicting transfusion needs.

A retrospective observational study was conducted on children (0-18 years) admitted to a tertiary academic PICU from January 2015 to December 2021. Demographic data, clinical parameters, and transfusion events were analyzed using Chi-square tests, logistic regression, and Kaplan-Meier estimation.

Of 2,011 patients, 27.7% ( n = 558) received at least one RBC transfusion, with a median pre-transfusion hemoglobin level of 8.9 g/dL [IQR: 8.1-9.6]. Anemia was present in 47.59% ( n = 957) at admission, with 48.17% ( n = 461) requiring transfusion. Younger age (0-2 years: OR 2.22, 95% CI 1.9-2.61) and lower weight-for-age Z (WFA-Z) scores (severely underweight: OR 1.64, 95% CI 1.2-2.24) were associated with increased transfusion likelihood. Multiple transfusions were linked to higher mortality risk (OR 15.16, 95% CI 8.0-28.73, P < 0.001).

Transfusion decisions in the PICU appeared to be influenced not only by hemoglobin values but also by age-related physiology, nutritional status, and baseline anemia. Anemia at discharge remained common, underscoring the need for structured post-discharge follow-up and prospective studies to refine individualized transfusion decision frameworks.