Transfusion guidelines in pediatric patients

ABSTRACT

To avoid unnecessary transfusions of blood products, a patient's current hematologic and hemodynamic status must be evaluated thoroughly by assessing on-going and anticipated bleeding using a pre-determined transfusion threshold, and overall physiological conditions should be monitored using various parameters. A large, randomized investigation of critically ill pediatric patients demonstrated that a restrictive approach, with a lower hemoglobin transfusion threshold of 7.0 g/dl, was not harmful during the immediate postoperative period, compared to a liberal hemoglobin policy of 9.0 g/dl. Subgroup analyses supported a restrictive policy in patients with more serious conditions. Furthermore, packed red blood cell transfusion was related to adverse postoperative outcomes, such as prolonged mechanical ventilation. Therefore, a "restrictive" policy can be adopted for intraoperative transfusion in otherwise healthy patients. However, more investigations are needed to replace the conventional "liberal" approach in patients with compromised oxygenation, such as cyanotic congenital heart disease or pulmonary insufficiency. There is no "universal" transfusion threshold for all pediatric patients.