Transfusions in the Critically Ill Pediatric Patient

Jelena Roganovic


Pediatr Health. 2010;4(2):201-208. 

In This Article

Abstract and Introduction


Anemia is one of the most common medical complications encountered in critically ill children. Based on the results of clinical trials, transfusion practices across the world have generally become more restrictive. The decision process leading to the conduction of a red blood cell transfusion should be based on available evidence as much as possible. The risks and benefits of the transfusion as well as the risks attributable to anemia must be taken into account. This review summarizes the current practice approach to the critically ill pediatric patient.


Critically ill patients in pediatric intensive care units (PICUs) are at significant risk for developing anemia. The causes are multifactorial and include overt and occult bleeding, iatrogenic blood loss through diagnostic phlebotomy, underlying disease, chronic anemia and treatment causing bone marrow suppression.[1] An inadequate erythropoietin response to anemia in critically ill children has been described.[2]

The optimal hemoglobin (Hb) threshold for conducting a red blood cell (RBC) transfusion in this group of patients is unknown, as is the target Hb concentration that the pediatrician should aim to achieve. Children have a different physiology and pathology compared with adults during their growth and development, and that should also be taken into consideration.[3] Historically, critically ill pediatric patients received an extraordinarily large number of RBC transfusions and recently conducted studies revealed that almost 50% of children who are admitted to PICUs are transfused.[4]

Red blood cell transfusions are associated with multiple disadvantages, including limited availability, high costs, multiple risks and side effects. This review summarizes the evaluation of anemia in acute illness and treatment guidelines in the pediatric emergency department.


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