title: Hemoglobin Threshold for Blood Transfusion in a Pediatric Intensive Care Unit.
abstract: OBJECTIVE
  To evaluate the hemoglobin threshold for red cell transfusion in children admitted to a pediatric intensive care unit (PICU).
  
  
  METHODS
  Retrospective chart review study. Tertiary care PICU. Critically ill pediatric patients requiring blood transfusion. No intervention.
  
  
  RESULTS
  We analyzed the charts of all children between 1 month and 21 years of age who received packed red blood cell (PRBC) transfusions during a 2-year period. The target patients were identified from our blood bank database. For analysis, the patients were subdivided into four groups: acute blood loss (postsurgically, trauma, or acute gastrointestinal bleeding from other causes), hematologic (hematologic malignancies, bone marrow suppression, hemolytic anemia, or sickle cell disease), unstable (FiO2> 0.6 and/or on inotropic support), and stable groups. We also compared the pre-transfusion hemoglobin threshold in all unstable patients with that of all stable patients. A total of 571 transfusion episodes in 284 patients were analyzed. 28% (n = 160) of transfusions were administered to patients in the acute blood loss group, 36% (n = 206) to hematologic patients, 17% (n = 99) to unstable patients, and 18% (n = 106) to stable patients. The mean pre-transfusion hemoglobin (± SD) in all children as well as in the acute blood loss, hematologic, unstable and stable groups was 7.3 ± 1.20, 7.83 ± 1.32, 6.97 ± 1.31, 7.96 ± 1.37, 7.31 ± 1.09 g/dl, respectively. The transfusion threshold for acute blood loss and unstable groups was higher compared to hematologic and stable groups (p < 0.001; ANOVA with multiple comparisons). The mean pre-transfusion hemoglobin threshold for stable and unstable patients among all groups was 7.3 ± 1.3 and 7.9 ± 1.3 (p < 0.0001), respectively. The observed mortality rate was higher among children who received transfusion compared to other children admitted to PICU.
  
  
  CONCLUSIONS
  The hemoglobin threshold for transfusion varied according to clinical conditions. Overall, the hemoglobin threshold for transfusion was 7.3 ± 1.20 g/dl.
authors.affiliation: Division of Critical Care Medicine and Nicklaus Children's Hospital (Formerly Miami Children's Hospital), Miami, FL, USA.
authors.forename: Madhuradhar
authors.initials: M
authors.lastname: Chegondi
authors.affiliation: Division of Critical Care Medicine and Nicklaus Children's Hospital (Formerly Miami Children's Hospital), Miami, FL, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Sasaki
authors.affiliation: Division of Critical Care Medicine and Nicklaus Children's Hospital (Formerly Miami Children's Hospital), Miami, FL, USA; Herberth Wertheim College of Medicine, Florida International University, Miami, FL, USA.
authors.forename: André
authors.initials: A
authors.lastname: Raszynski
authors.affiliation: Division of Critical Care Medicine and Nicklaus Children's Hospital (Formerly Miami Children's Hospital), Miami, FL, USA; Herberth Wertheim College of Medicine, Florida International University, Miami, FL, USA.
authors.forename: Balagangadhar R
authors.initials: BR
authors.lastname: Totapally
keywords: Children; Hemoglobin; PICU; Packed red blood cell; Threshold; Transfusion