Anemia, blood loss, and blood transfusions in North American children in the intensive care unit

UMMS Affiliation

Department of Pediatrics

Publication Date


Document Type



Adolescent; Anemia; Blood Specimen Collection; Canada; Child; Child, Preschool; Critical Illness; *Erythrocyte Transfusion; Female; Hemorrhage; Humans; Infant; Infant, Newborn; *Intensive Care Units, Pediatric; Length of Stay; Male; Respiration, Artificial; Risk Factors; United States


Life Sciences | Medicine and Health Sciences | Pediatrics


RATIONALE: Minimizing exposure of children to blood products is desirable.

OBJECTIVES: We aimed to understand anemia development, blood loss, and red blood cell (RBC) transfusions in the pediatric intensive care unit (PICU).

METHODS: Prospective, multicenter, 6-month observational study in 30 PICUs. Data were collected on consecutive children (<18 yr>old) in the PICU for 48 hours or more.

MEASUREMENTS AND MAIN RESULTS: Anemia development, blood loss, and RBC transfusions were measured. A total of 977 children were enrolled. Most (74%) children were anemic in the PICU (33% on admission, 41% developed anemia). Blood draws accounted for 73% of daily blood loss; median loss was 5.0 ml/day. Forty-nine percent of children received transfusions; 74% of first transfusions were on Days 1-2. After adjusting for age and illness severity, compared with nontransfused children, children who underwent transfusion had significantly longer days of mechanical ventilation (2.1 d, P < 0.001) and PICU stay (1.8 d, P = 0.03), and had increased mortality (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.43-90.9; P = 0.02), nosocomial infections (OR, 1.9; 95% CI, 1.2-3.0; P = 0.004), and cardiorespiratory dysfunction (OR, 2.1; 95% CI, 1.5-3.0; P < 0.001). High blood loss per kilogram body weight from blood draws (OR, 1.11; 95% CI, 1.03-1.2; P = 0.01) was associated with RBC transfusion more than 48 hours after admission. The most common indication for transfusion was low hemoglobin (42%). Pretransfusion hemoglobin values varied greatly (mean, 9.7 +/- 2.7 g/dl).

CONCLUSIONS: Critically ill children are at significant risk for developing anemia and receiving blood transfusions. Transfusion in the PICU was associated with worse outcomes. It is imperative to minimize blood loss from blood draws and to set clear transfusion thresholds.

DOI of Published Version



Am J Respir Crit Care Med. 2008 Jul 1;178(1):26-33. Epub 2008 Apr 17. Link to article on publisher's site

Journal/Book/Conference Title

American journal of respiratory and critical care medicine

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PubMed ID