Chapter 11
Transfusion and Anticoagulation
Robert L. Ricca, MD
Marjorie J. Arca, MD
I. Introduction
The oxygen carrying capacity of hemoglobin and its role in oxygen
delivery is well understood. Transfusion of packed red blood cells has, therefore,
become an important tool in the armamentarium of intensivists, and surgeons
alike, in an attempt to reduce the oxygen debt associated with an underlying
disease process. This topic remains relevant as up to 50% of children receive a
blood transfusion during their stay in the pediatric intensive care unit (PICU) and
almost 80% of extremely low birth weight (ELBW) infants receive a transfusion
[1,2].
Currently no absolute value of hemoglobin concentration below which
transfusion is mandated exists. There are multiple physiologic variables that
dictate the necessity of transfusion. These include the rapidity of drop in
hemoglobin or hematocrit, associated cardio-respiratory collapse or compromise,
infection, injury to the CNS or physiologic anemia as seen in premature infants.
Defining this transfusion level has been the centerpiece of most recent literature
on transfusion medicine. The impetus for these studies was the complication
profile seen after transfusions including transmission of infectious disease, fluid
overload and acute lung injury seen in patients post-transfusion. The underlying
immunosuppression seen in many of our pediatric patients due to malignancy or