Transfusion guidelines in pediatric patients

Lee, Jong Wha

doi:2015.10.3.141

Anesth Pain Med > Volume 10(3); 2015 > Article

Review

Pediatric Anesthesia

Anesthesia and Pain Medicine 2015;10(3):141-148.
DOI: https://doi.org/10.17085/apm.2015.10.3.141 Published online July 31, 2015.

Transfusion guidelines in pediatric patients

Jong Wha Lee

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. jhanes@yuhs.ac

Received: 13 April 2015 • Accepted: 20 April 2015

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.

Key Words: Blood transfusion, Practice guideline, Pediatric patients