title: Anemia, blood loss, and blood transfusions in North American children in the intensive care unit.
abstract: BACKGROUND
  Minimizing exposure of children to blood products is desirable.
  
  
  OBJECTIVE
  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.
  
  
  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 for age 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.
authors.affiliation: Department of Pediatrics, University of Massachusetts Medical Center, H5-524, 55 Lake Avenue, North Worcester, MA 01655, USA. batemans@ummhc.org
authors.forename: Scot T
authors.initials: ST
authors.lastname: Bateman
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
authors.forename: Katia
authors.initials: K
authors.lastname: Boven
authors.forename: Peter
authors.initials: P
authors.lastname: Forbes
authors.forename: Roger
authors.initials: R
authors.lastname: Barton
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Thomas
authors.forename: Brian
authors.initials: B
authors.lastname: Jacobs
authors.forename: Barry
authors.initials: B
authors.lastname: Markovitz
authors.forename: Brahm
authors.initials: B
authors.lastname: Goldstein
authors.forename: James H
authors.initials: JH
authors.lastname: Hanson
authors.forename: H Agnes
authors.initials: HA
authors.lastname: Li
authors.forename: Adrienne G
authors.initials: AG
authors.lastname: Randolph
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D001800:Blood Specimen Collection / Q000009:adverse effects; D002170:Canada; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D017707:Erythrocyte Transfusion; D005260:Female; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial; D012307:Risk Factors; D014481:United States