Published ahead of print on April 17, 2008, doi:10.1164/rccm.200711-1637OC Am. J. Respir. Crit. Care Med., Volume 178, Number 1, July 2008, 26-33 A more recent version of this article appeared on July 1, 2008
Submitted on November 6, 2007 Anemia, Blood Loss, and Blood Transfusions in North American Children in the Intensive Care UnitScot T Bateman1*,1 University of Massachusetts Medical Center, Worcester, MA, USA, 2 CHU Sainte-Justine, Montreal, PQ, Canada, 3 Research and Development, Johnson and Johnson Pharmaceutical, Raritan, NJ, USA, 4 Children's Hospital, Boston, MA, USA, 5 Children's Hospital of Saint Francis, Tulsa, OK, USA, 6 Penn State Children's Hospital, Hershey, PA, USA, 7 Children's National Medical Center, Washington, DC, USA, 8 Childrens Hospital of Los Angeles, Los Angeles, CA, USA, 9 Novo Nordisk Inc., Princeton, NJ, USA, 10 Children's Hospital and Research Center Oakland, Oakland, CA, USA * To whom correspondence should be addressed. E-mail: batemans{at}ummhc.org.
Rationale: Minimizing exposure of children to blood products is desirable.
Objective: We aimed to understand anemia development, blood loss, and red blood cell (RBC) transfusions in the Pediatric Intensive Care Unit (PICU).
Methods: Prospective, multi-center, 6 month observational study in 30 PICUs. Data were collected on consecutive children (<18 years old) in the PICU Key words: blood loss, anemia, transfusions, pediatric, intensive care
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48 hours.
Measurements: Anemia development, blood loss, and RBC transfusions.
Main Results: 977 children were enrolled. Most (74%) children were anemic in the PICU (33% on admission, 41% developed anemia). Blood draws accounted for 73% of
daily blood loss; median loss was 5.0 ml/day. 49% of children were transfused; 74% of 1st transfusions were on days 1-2. After adjusting for age and illness severity, compared to non-transfused children, transfused children had significantly longer days of mechanical ventilation (2.1 days (p<0.001)) and PICU stay (1.8 days (p=0.03)), and had increased mortality (OR 11.6, 95% CI 1.43-90.9, p=0.02), nosocomial infections (OR 1.9, 95% CI 1.2-3.0, p=0.004), and cardio-respiratory dysfunction (OR 2.1, 95% CI 1.5- 3.0 p<0.001). High blood loss/kg from blood draws (OR 1.11, 95%CI 1.03-1.2, p=0.01) was associated with RBC transfusion >48 hours after admission. The most common
indication for transfusion was low hemoglobin (42%). Pre-transfusion hemoglobin values varied greatly (mean 9.7 ± 2.7 g/dL).
Conclusions: Critically ill children are at significant risk for developing anemia and receiving blood transfusions. Transfusion in the PICU was associated with worse outcomes. It is imperative to minimize blood loss from blood draws and to set clear transfusion thresholds.