TY - JOUR
T1 - Anemia, blood loss, and blood transfusions in North American children in the intensive care unit
AU - Bateman, Scot T.
AU - Lacroix, Jacques
AU - Boven, Katia
AU - Forbes, Peter
AU - Barton, Roger
AU - Thomas, Neal J.
AU - Jacobs, Brian
AU - Markovitz, Barry
AU - Hanson, James H.
AU - Li, H. Agnes
AU - Abd-Allah, Shamile
AU - Randolph, Adrienne
AU - Healey, Heather
AU - Besunder, James
AU - Blumer, Jeffrey
AU - Cheiftez, Ira
AU - Bass, Andora
AU - Dalton, Heidi
AU - Dobyns, Emily
AU - Fitch, Jill
AU - Gedeit, Rainer
AU - Goldstein, Brahm
AU - Grzeszczak, Marek
AU - Hasan, Rashed
AU - Jefferson, Larry
AU - Levin, Daniel
AU - Jarvis, Dean
AU - Newth, Christopher
AU - Randolph, Adrienne G.
AU - Auw, Lori
AU - Patel, Vipul
AU - Ron, Steven
AU - Correa, Charlene S.
AU - Seferian, Edward
AU - Hess, Joseph
AU - Stokes, Jennifer
AU - Willson, Douglas
AU - Cox, Peter
AU - Joffe, Ari
AU - Menon, Kusum
AU - Wensley, David
PY - 2008/7/1
Y1 - 2008/7/1
N2 - Rationale: Minimizing exposure of children to blood products is desirable. Objectives: We aimed to understand anemia development, blood loss, and red blood cell (RBC) transfusions in the pediatric intensive care unit (PICU). Methods; Prospective, multicenter, 6-month observational study in 30 PICUs. Data were collected on consecutive children (< 18 yr old) in the PICU for 48 hours or more. Measurements and Main Results: Anemia development, blood loss, and RBC transfusions were measured. A total of 977 children were enrolled. Most (74%) children were anemic in the PICU (33% on admission, 41 % developed anemia). Blood draws accounted for 73% of daily blood loss; median loss was 5.0 ml/day. Forty-nine percent of children received transfusions; 74% of first transfusions were on Days 1-2. After adjusting forage and illness severity, compared with nontransfused children, children who underwent transfusion had significantly longer days of mechanical ventilation (2.1 d, P< 0.001) and PICU stay (1.8 d, P = 0.03), and had increased mortality (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.43-90.9; P = 0.02), nosocomial infections (OR, 1.9; 95% CI, 1.2-3.0; P = 0.004), and cardiorespiratory dysfunction (OR, 2.1; 95% CI, 1.5-3.0; P < 0.001). High blood loss per kilogram body weight from blood draws (OR, 1.11; 95% CI, 1.03-1.2; P = 0.01) was associated with RBC transfusion more than 48 hours after admission. The most common indication for transfusion was low hemoglobin (42%). Pretransfusion hemoglobin values varied greatly (mean, 9.7 ± 2.7 g/dl). Conclusions: Critically ill children are at significant risk for developing anemia and receiving blood transfusions. Transfusion in the PICU was associated with worse outcomes. It is imperative to minimize blood loss from blood draws and to set clear transfusion thresholds.
AB - Rationale: Minimizing exposure of children to blood products is desirable. Objectives: We aimed to understand anemia development, blood loss, and red blood cell (RBC) transfusions in the pediatric intensive care unit (PICU). Methods; Prospective, multicenter, 6-month observational study in 30 PICUs. Data were collected on consecutive children (< 18 yr old) in the PICU for 48 hours or more. Measurements and Main Results: Anemia development, blood loss, and RBC transfusions were measured. A total of 977 children were enrolled. Most (74%) children were anemic in the PICU (33% on admission, 41 % developed anemia). Blood draws accounted for 73% of daily blood loss; median loss was 5.0 ml/day. Forty-nine percent of children received transfusions; 74% of first transfusions were on Days 1-2. After adjusting forage and illness severity, compared with nontransfused children, children who underwent transfusion had significantly longer days of mechanical ventilation (2.1 d, P< 0.001) and PICU stay (1.8 d, P = 0.03), and had increased mortality (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.43-90.9; P = 0.02), nosocomial infections (OR, 1.9; 95% CI, 1.2-3.0; P = 0.004), and cardiorespiratory dysfunction (OR, 2.1; 95% CI, 1.5-3.0; P < 0.001). High blood loss per kilogram body weight from blood draws (OR, 1.11; 95% CI, 1.03-1.2; P = 0.01) was associated with RBC transfusion more than 48 hours after admission. The most common indication for transfusion was low hemoglobin (42%). Pretransfusion hemoglobin values varied greatly (mean, 9.7 ± 2.7 g/dl). Conclusions: Critically ill children are at significant risk for developing anemia and receiving blood transfusions. Transfusion in the PICU was associated with worse outcomes. It is imperative to minimize blood loss from blood draws and to set clear transfusion thresholds.
UR - http://www.scopus.com/inward/record.url?scp=46349095109&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=46349095109&partnerID=8YFLogxK
U2 - 10.1164/rccm.200711-1637OC
DO - 10.1164/rccm.200711-1637OC
M3 - Article
C2 - 18420962
AN - SCOPUS:46349095109
SN - 1073-449X
VL - 178
SP - 26
EP - 33
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 1
ER -