Anemia, blood loss, and blood transfusions in North American children in the intensive care unit

Scot T. Bateman, Jacques Lacroix, Katia Boven, Peter Forbes, Roger Barton, Neal J. Thomas, Brian Jacobs, Barry Markovitz, James H. Hanson, H. Agnes Li, Shamile Abd-Allah, Adrienne Randolph, Heather Healey, James Besunder, Jeffrey Blumer, Ira Cheiftez, Andora Bass, Heidi Dalton, Emily Dobyns, Jill FitchRainer Gedeit, Brahm Goldstein, Marek Grzeszczak, Rashed Hasan, Larry Jefferson, Daniel Levin, Dean Jarvis, Christopher Newth, Adrienne G. Randolph, Lori Auw, Vipul Patel, Steven Ron, Charlene S. Correa, Edward Seferian, Joseph Hess, Jennifer Stokes, Douglas Willson, Peter Cox, Ari Joffe, Kusum Menon, David Wensley

Research output: Contribution to journalArticlepeer-review

219 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)26-33
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Issue number1
StatePublished - Jul 1 2008

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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