Transfusions in Critically Ill Children

Transfusions in Critically Ill Children

A liberal transfusion policy does not confer benefit and leads to more transfusions.

A restrictive transfusion policy in critically ill adults may be superior to a liberal strategy, but the optimal strategy in children is unknown. In a multisite clinical trial, researchers randomly assigned 637 stable critically ill children (age range, 3 days–14 years) with hemoglobin (Hb) concentrations of 9.5 g/dL or lower to either a restrictive transfusion protocol (Hb threshold, 7 g/dL with a target of 8.5–9.5 g/dL) or a liberal transfusion protocol (Hb threshold, 9.5 g/dL with a target of 11–12 g/dL) for up to 28 days in the ICU or until death.

During the study, the average difference in Hb levels between the two groups was 2.1 g/dL. No differences between groups were observed in primary outcomes, including death or multiple organ dysfunction. The restrictive-protocol group received 44% fewer transfusions than the liberal-protocol group, and significantly fewer patients in the restrictive group received transfusions (46% vs. 98%).

Comment: For decades, blood transfusions have been considered to confer clinical benefit. Recently, however, concerns have been raised that high Hb levels are harmful in adults with renal disease (see Journal Watch Feb 15 2007) and that higher Hb levels are not helpful in critically ill adults (see Journal Watch Feb 12 1999). The current study suggests that a liberal transfusion policy in critically ill children does not confer benefit and leads to more transfusions in more children.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine April 18, 2007