title: Transfusion in critically ill children: an ongoing dilemma.
abstract: Transfusion of blood products is a cornerstone in managing many critically ill children. Major improvements in blood product safety have not diminished the need for caution in transfusion practice. In this review, we aim to discuss the interplay between benefits and potential adverse effects of transfusion in critically ill children by including 65 papers, which were evaluated based on previously agreed selection criteria. Current practice on transfusing critically ill children is mainly founded on the basis of adult studies, common practices with cut-off values, and expert opinions, rather than evidence-based medicine. Paediatric patients have explicit physiological challenges and requirements to be addressed. Critically ill children often suffer from anaemia, have substantial iatrogenic blood loss with subsequent transfusions, and are at a higher risk of complications, often due to human errors. Transfusion in children is associated with increased morbidity. A restrictive transfusion strategy is not associated with increased morbidity. Thus, transfusion in paediatrics should be considered a high-risk treatment and requires individual clinical assessment. Current level of evidence support the notion that in most stable cases, despite high severity of illness (cyanotic children and neonates excluded), a restrictive haemoglobin threshold of 70 g/l (4.3 mmol/l) is no more harmful than to transfuse at a liberal trigger, e.g. haemoglobin 95 g/l (5.9 mmol/l). Thus, balanced against potential benefits and often its necessity, a restrictive approach may be appropriate due to the associated risks of transfusion.
authors.affiliation: Department of Anaesthesiology, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. eriksecher@gmail.com
authors.forename: E L
authors.initials: EL
authors.lastname: Secher
authors.forename: J
authors.initials: J
authors.lastname: Stensballe
authors.forename: A
authors.initials: A
authors.lastname: Afshari
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology; D000293:Adolescent; D000740:Anemia / Q000628:therapy; D001787:Blood Group Incompatibility; D001803:Blood Transfusion / Q000706:statistics & numerical data; D017848:Blood-Borne Pathogens; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D000860:Hypoxia / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D019190:Iron Overload / Q000209:etiology; D019300:Medical Errors; D010108:Oxyhemoglobins / Q000378:metabolism; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000628:therapy; D017410:Practice Guidelines as Topic; D011997:Recovery Room / Q000706:statistics & numerical data; D018570:Risk Assessment; D065227:Transfusion Reaction
chemical_list: D006454:Hemoglobins; D010108:Oxyhemoglobins