title: Hemoglobin thresholds for transfusion in pediatric patients at a large academic health center.
abstract: BACKGROUND
  Although prior studies support the use of a hemoglobin (Hb) transfusion trigger of 7 to 8 g/dL for most hospitalized adults, there are few studies in pediatric populations. We therefore investigated transfusion practices and Hb triggers in hospitalized children.
  
  
  METHODS
  We performed a historical cohort study comparing transfusion practices in hospitalized children by service within a single academic institution. Blood utilization data from transfused patients (n = 3370) were obtained from electronic records over 4 years. Hb triggers and posttransfusion Hb levels were defined as the lowest and last Hb measured during hospital stay, respectively, in transfused patients. The mean and percentile distribution for Hb triggers were compared to the evidence-based restrictive transfusion threshold of 7 g/dL.
  
  
  RESULTS
  Mean Hb triggers were above the restrictive trigger (7 g/dL) for eight of 12 pediatric services. Among all of the services, there were significant differences between the mean Hb triggers (>2.5 g/dL, p<0.0001) and between the posttransfusion Hb levels (>3 g/dL, p < 0.0001). The variation between the 10th and 90th percentiles for triggers (up to 4 g/dL, p < 0.0001) and posttransfusion Hb levels (up to 6 g/dL, p < 0.0001) were significant. Depending on the service, between 25 and 90% of transfused patients had Hb triggers higher than the restrictive range.
  
  
  CONCLUSIONS
  Red blood cell (RBC) transfusion therapy varies significantly in hospitalized children with mean Hb triggers above a restrictive threshold for most services. Our findings suggest that transfusions may be overused and that implementing a restrictive transfusion strategy could decrease the use of RBC transfusions, thereby reducing the associated risks and costs.
authors.affiliation: Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Sybil A
authors.initials: SA
authors.lastname: Klaus
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
authors.affiliation: Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Jose H
authors.initials: JH
authors.lastname: Salazar
authors.affiliation: Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Stacy
authors.initials: S
authors.lastname: Cooper
authors.affiliation: Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Lauren
authors.initials: L
authors.lastname: Beard
authors.affiliation: Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: James C
authors.initials: JC
authors.lastname: Fackler
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Eugenie S
authors.initials: ES
authors.lastname: Heitmiller
authors.affiliation: Department of Pathology (Transfusion Medicine), the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.affiliation: Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland.|Departments of Medicine (Hematology), Oncology, & Institute for Cellular Engineering, the Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Linda M S
authors.initials: LM
authors.lastname: Resar
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D006454:Hemoglobins