Red Blood Cell Transfusion in the Pediatric ICU

  • J. Lacroix
  • M. Tucci
  • F. Gauvin


The decision process leading to red blood cell (RBC) transfusion should be based as much as possible on available evidence. Risks and benefits of transfusion as well as the risks attributable to anemia must be taken into account. In this chapter, we will discuss what prompts pediatric intensivists to prescribe a RBC transfusion, what should guide this decision, and what is missing to really make a decision based on an evidence-based approach.


Hemoglobin Concentration Pediatric Intensive Care Unit Hemorrhagic Shock Multiple Organ Dysfunction Syndrome Cyanotic Heart Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hebert PC, Wells G, Martin C, et al (1998) A Canadian survey of transfusion practices in critically ill patients. Crit Care Med 26:482–487PubMedCrossRefGoogle Scholar
  2. 2.
    Laverdiere C, Gauvin F, Hébert PC, et al (2002) Survey of transfusion practices in pediatric intensive care units. Pediatr Crit Care Med 3:335–340PubMedCrossRefGoogle Scholar
  3. 3.
    Nahum E, Ben-Ari J, Schonfeld T (2004) Blood transfusion policy among European pediatric intensive care physicians. J Intensive Care Med 19:38–43PubMedCrossRefGoogle Scholar
  4. 4.
    Gauvin F, Chaïbou M, Leteurtre S, et al (2000) Pratique de transfusion de concentré globulaire en réanimation pédiatrique: une étude descriptive prospective. Réanimation Urgences 9:339–344CrossRefGoogle Scholar
  5. 5.
    Lacroix J, Tucci M (2004) RBC transfusion in the PICU: The right cutoff? In: Shanley TP (ed) Current Concepts in Pediatric Critical Care Course. Society of Critical Care Medicine, Des Plaines, pp 119–135Google Scholar
  6. 6.
    Hébert PC, Wells G, Blajchman MA, et al (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409–17PubMedCrossRefGoogle Scholar
  7. 7.
    Lacroix J, Hebert PC, Hutchison JH, et al (2007) Transfusion requirements in pediatric intensive care units (TRIPICU) study — A multicenter randomized controlled noninferiority clinical trial. N Engl J Med (in press)Google Scholar
  8. 8.
    Luban NLC, Strauss RG, Hume HA (1991) Commentary on the safety of red cells preserved in extended-storage media for neonatal transfusions. Transfusion 31:229–235PubMedCrossRefGoogle Scholar
  9. 9.
    Shanwell A, Kristiansson M, Remberger M, Ringden O (1997) Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction. Transfusion 37:678–684PubMedCrossRefGoogle Scholar
  10. 10.
    Stack G, Baril L, Napychank P, Snyder EL (1995) Cytokine generation in stored, white cell-reduced, and bacterially contaminated units of red cells. Transfusion 35:199–203PubMedCrossRefGoogle Scholar
  11. 11.
    Smith KJ, Sierra ER, Nelson EJ (1993) Histamine, IL-lb and IL-8 increase in packed RBCs stored for 42 days but not in RBCs leukodepleted pre-storage. Transfusion 33:53SCrossRefGoogle Scholar
  12. 12.
    van de Watering LMG, Hermans J, Houbiers JGA, et al (1998) Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery. Circulation 97:562–568PubMedGoogle Scholar
  13. 13.
    Fergusson D, Hebert PC, Lee SK, et al (2003) Clinical outcomes following institution of universal leukoreduction of blood transfusions for premature infants. JAMA 289:1950–6PubMedCrossRefGoogle Scholar
  14. 14.
    Yazer MH, Podlosky L, Clarke G, Nahirniak SM (2004) The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC. Transfusion 44:10–15PubMedCrossRefGoogle Scholar
  15. 15.
    Desmet L, Lacroix J. Transfusion in pediatrics. Crit Care Clin 2004;20:299–311PubMedCrossRefGoogle Scholar
  16. 16.
    Corwin HL, Gettinger A, Pearl RG, et al (2004) The CRIT Study: Anemia and blood transfusion in the critically ill-current clinical practice in the United States. Crit Care Med 32:39–52PubMedCrossRefGoogle Scholar
  17. 17.
    Carson JL, Duff A, Poses RM, et al (1996) Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 348:1055–1060PubMedCrossRefGoogle Scholar
  18. 18.
    Carson JL, Noveck H, Berlin JA, Gould SA (2002) Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion 42:812–818PubMedCrossRefGoogle Scholar
  19. 19.
    Lackritz EM, Campbell CC, Ruebush TK, et al (1992) Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet 340:524–528PubMedCrossRefGoogle Scholar
  20. 20.
    Lackritz EM, Hightower AW, Zucker JR, et al (1997) Longitudinal evaluation of severely anemic children in Kenya: The effect of transfusion on mortality and hematologic recovery. AIDS 11:1487–1494PubMedCrossRefGoogle Scholar
  21. 21.
    English M, Ahmed M, Ngando C, Berkley J, Ross A (2002) Blood transfusion for severe anaemia in children in a Kenyan hospital. Lancet 359:494–495PubMedCrossRefGoogle Scholar
  22. 22.
    Bell EF, Strauss RG, Widness JA, et al (2005) Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 115:1685–1691PubMedCrossRefGoogle Scholar
  23. 23.
    Goodman A, M, Pollack MM, Patel KM, Luban NLC (2003) Pediatric red blood cell transfusions increase resource use. J Pediatr 142:123–127PubMedCrossRefGoogle Scholar
  24. 24.
    Rivers E, Nguyen B, Havstad S, et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRefGoogle Scholar
  25. 25.
    Rivers EP (2006) Fluid-management strategies in acute lung injury — liberal, conservative, or both? N Engl J Med 354:2598–300PubMedCrossRefGoogle Scholar
  26. 26.
    Weiskopf RB, Viele MK, Feiner J, et al (1998) Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA 279:217–221PubMedCrossRefGoogle Scholar
  27. 27.
    Rasanen J (1992) Supply-dependent oxygen consumption and mixed venous oxyhemoglobin saturation during isovolemic hemodilution in pigs. Chest 101:1121–1124PubMedGoogle Scholar
  28. 28.
    Shander A (2004) Anemia in the critically ill. Crit Care Clin 20:159–78PubMedCrossRefGoogle Scholar
  29. 29.
    Habib RH, Zacharias A, Schwann TA, et al (2005) Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: Implications on operative outcome. Crit Care Med 33:1749–1756PubMedCrossRefGoogle Scholar
  30. 30.
    Jonas RA, Wypij D, Roth SJ, et al (2003) The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: Results of a randomized trial in infants. J Thorac Cardiovasc Surg 126:1765–1774PubMedCrossRefGoogle Scholar
  31. 31.
    Armano R, Gauvin F, Ducruet T, Hume H, Lacroix J (2005) Determinants of red blood cell transfusions in a pediatric critical care unit: A prospective descriptive epidemiological study. Crit Care Med 33:2637–2644PubMedCrossRefGoogle Scholar
  32. 32.
    Gibson BE, Todd A, Roberts I, et al (2004) Transfusion guidelines for neonates and older children. Br J Haematol 124:433–453PubMedCrossRefGoogle Scholar
  33. 33.
    Beekman RH, Tuuri DT (1985) Acute hemodynamic effects of increasing hemoglobin concentration in children with a right to left ventricular shunt and relative anemia. J Am Coll Cardiol 5:357–62PubMedCrossRefGoogle Scholar
  34. 34.
    Williams GD, Bratton SL, Ramamoorthy C (1999) Factors associated with blood loss and blood product transfusions: A multivariate analysis in children after open-heart surgery. Anesth Analg 89:57–64PubMedCrossRefGoogle Scholar
  35. 35.
    Riddington C, Williamson L (2001) Preoperative blood transfusions for sickle cell disease. Cochrane Database Syst Rev:CD003149Google Scholar
  36. 36.
    Jacob E, Miaskowski C, Savedra M, Beyer JE, Treadwell M, Styles L (2003) Management of vaso-occlusive pain in children with sickle cell disease. J Pediatr Hematol Oncol 25:307–311PubMedCrossRefGoogle Scholar
  37. 37.
    Van den Berghe G, Wouters P, Weekers F, et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRefGoogle Scholar
  38. 38.
    Tucci M, Lacroix J (2006) Goal-directed blood transfusion therapies. In: Nadkarni VM (ed) Current Concepts in Pediatric Critical Care Course. Society of Critical Care Medicine, Des Plaines, pp 103–120Google Scholar
  39. 39.
    Rana R, Afessa B, Keegan MT, et al (2006) Evidence-based red cell transfusion in the critically ill: Quality improvement using computerized physician order entry. Crit Care Med 34:1892–1897PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • J. Lacroix
    • 1
  • M. Tucci
    • 1
  • F. Gauvin
    • 1
  1. 1.Division of Pediatric Critical Care MedicineSainte-Justine HospitalMontrealCanada

Personalised recommendations