Association between red blood cell transfusion and mortality in critically ill children: a single-center pediatric intensive care experience

Abstract

Aims: Our study aimed to evaluate the association of erythrocyte transfusion with mortality and morbidity in critically ill children and to emphasize the importance of the risk it carries. Methods: A retrospective evaluation of 524 pediatric patients aged 1 month to 18 years who had been admitted between February 2022 to March 2023 at Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, were performed. Children with hemoglobinopathies, and chronic anemia (defined as the presence of anemia for more than 6 weeks) were excluded. Demographic data, clinical variables, and outcome data were analyzed. Results: The median age was 36.5 (1.0-272.0) months, and 56.1% of the patients were male. The median duration of a pediatric intensive care unit stay was 5 (1-114) days. Respiratory diseases (44.7%) were the most common reasons for admission to the pediatric intensive care unit, followed by, neurological diseases (12.8%)and sepsis (11.3%). Mortality rate was 5.7%. The median baseline hemoglobin level upon admission was 10.5 g/dl (3.2-18.8). Severe anemia (hemoglobin < 7 g/dl was present in 6.1% of all patients. One hundred and sixteen (22.1%) patients were transfused; 61 (11.6%) were transfused only once. A total of 292 packed red blood cells transfusions were administered. Transfused patients required prolonged hospital stays, support for inotropic agents, invasive mechanical ventilation, and extracorporeal treatment and had an excessive mortality rate (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001). Conclusion: Clinicians should consider that the administration of packed red blood cells transfusions in critically ill patients may have the potential to both raise mortality and provide life-saving benefits during their pediatric intensive care unit stay. As with any treatment with potential side effects, it is essential to reduce the use of unnecessary blood products.