TY - JOUR
T1 - Red blood cell transfusion in critically ill children
T2 - A narrative review
AU - Istaphanous, George K.
AU - Wheeler, Derek S.
AU - Lisco, Steven J.
AU - Shander, Aryeh
N1 - Funding Information:
This study was supported, in part, by the Cincinnati Children's Research Foundation, Department of Anesthesia, Cincinnati Children's Hospital Medical Center, and Grants K08 GM077432 (DSW) and R03 HD058246 (DSW) from the National Institutes of Health.
PY - 2011/3
Y1 - 2011/3
N2 - Objective: To review the pathophysiology of anemia, as well as transfusion-related complications and indications for red blood cell (RBC) transfusion, in critically ill children. Although allogeneic blood has become increasingly safer from infectious agents, mounting evidence indicates that RBC transfusions are associated with complications and unfavorable outcomes. As a result, there has been growing interest and efforts to limit RBC transfusion, and indications are being revisited and revamped. Although a so-called restrictive RBC transfusion strategy has been shown to improve morbidity and mortality in critically ill adults, there have been relatively few studies on RBC transfusion performed in critically ill children. Data Sources: Published literature on transfusion medicine and outcomes of RBC transfusion. Study Selection, Data Extraction, And Synthesis: After a brief overview of physiology of oxygen transportation, anemia compensation, and current transfusion guidelines based on available literature, risks and outcomes of transfusion in general and in critically ill children are summarized in conjunction with studies investigating the safety of restrictive transfusion strategies in this patient population. Conclusions: The available evidence does not support the extensive use of RBC transfusions in general or critically ill patients. Transfusions are still associated with risks, and although their benefits are established in limited situations, the associated negative outcomes in many more patients must be closely addressed. Given the frequency of anemia and its proven negative outcomes, transfusion decisions in the critically ill children should be based on individual patient's characteristics rather than generalized triggers, with consideration of potential risks and benefits, and available blood conservation strategies that can reduce transfusion needs.
AB - Objective: To review the pathophysiology of anemia, as well as transfusion-related complications and indications for red blood cell (RBC) transfusion, in critically ill children. Although allogeneic blood has become increasingly safer from infectious agents, mounting evidence indicates that RBC transfusions are associated with complications and unfavorable outcomes. As a result, there has been growing interest and efforts to limit RBC transfusion, and indications are being revisited and revamped. Although a so-called restrictive RBC transfusion strategy has been shown to improve morbidity and mortality in critically ill adults, there have been relatively few studies on RBC transfusion performed in critically ill children. Data Sources: Published literature on transfusion medicine and outcomes of RBC transfusion. Study Selection, Data Extraction, And Synthesis: After a brief overview of physiology of oxygen transportation, anemia compensation, and current transfusion guidelines based on available literature, risks and outcomes of transfusion in general and in critically ill children are summarized in conjunction with studies investigating the safety of restrictive transfusion strategies in this patient population. Conclusions: The available evidence does not support the extensive use of RBC transfusions in general or critically ill patients. Transfusions are still associated with risks, and although their benefits are established in limited situations, the associated negative outcomes in many more patients must be closely addressed. Given the frequency of anemia and its proven negative outcomes, transfusion decisions in the critically ill children should be based on individual patient's characteristics rather than generalized triggers, with consideration of potential risks and benefits, and available blood conservation strategies that can reduce transfusion needs.
KW - blood conservation
KW - children
KW - critical illness
KW - erythrocyte
KW - intensive care unit
KW - pediatrics
KW - red blood cell transfusion
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=79953112846&partnerID=8YFLogxK
U2 - 10.1097/PCC.0b013e3181e30d09
DO - 10.1097/PCC.0b013e3181e30d09
M3 - Review article
AN - SCOPUS:79953112846
SN - 1529-7535
VL - 12
SP - 174
EP - 183
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 2
ER -