- Hematocrit of > 35%
IV. Transfusion in the PICU
A study of over 1000 admissions to the PICU showed that the four
significant determinants for red blood cell transfusion during an ICU stay were: a
hemoglobin level < 9.5 during the PICU stay, an admission diagnosis of cardiac
disease, an admission Pediatric Risk of Mortality score > 10 and the presence of
multi-organ dysfunction syndrome during the stay. Only the latter of these were
concerning for increased oxygen demand and oxygen debt that would be treated
by increasing the hemoglobin level [15].^ Bateman et al, looked prospectively at
977 children admitted to an intensive care unit. Children who did receive a
transfusion had longer days of mechanical ventilation, increased nosocomial
infection and increased mortality. Interestingly, the most common reason for
transfusion was low hemoglobin and the average pre-transfusion hemoglobin
was 9.7 g/dl [16].
In 2007, members of the Canadian Critical Care Trials group along with
Pediatric Acute Lung Injury and Sepsis Investigators Network (PALISI) reported
their use of a restrictive transfusion guideline in children. 637 children were
enrolled and randomized to receive transfusion for hemoglobin levels of 7 g/dl or
9.5 g/dl. Hemoglobin levels were significantly lower in children in the restrictive
arm during the study (8.7 g/dl vs. 10.8 g/dl). Patients in the restrictive arm also
received 44% fewer transfusions. There was no difference in the rate of new or
progressive multiple organ dysfunction between the two groups (12% in each