Demaret P1, Tucci M, Karam O, Trottier H, Ducruet T, Lacroix J.
Pediatr Crit Care Med. 2015 Apr 22
This prospective observational study of all children admitted to a Canadian tertiary care PICU over a 1-year period identifies the potential complications associated with RBC transfusions. A total of 842 consecutive admissions were included and 578 transfusions were given. 17% of patients were transfused at least once. When comparing transfused cases with nontransfused cases, the odds ratio for new or progressive multiple organ dysfunction syndrome was 2.39. Transfused cases were ventilated longer than nontransfused cases (14.1 ± 32.6 d vs 4.3 ± 9.6 d; p < 0.001). The PICU length of stay was significantly increased for transfused cases (12.4 ± 26.2 d vs 4.9 ± 10.2 d; p < 0.001), even after controlling for potential confounders. The paired analysis for comparison of pretransfusion and posttransfusion values showed that the arterial partial pressure in oxygen was significantly reduced after the first RBC transfusion (mean difference, 42.8 torr; 95% CI, 27.2-58.3; p < 0.001).
The authors report an independent and dose-effect relationship between RBC transfusions and increased morbidity in critically ill children; prolonged mechanical ventilation, new or progressive multiple organ dysfunction syndrome and prolonged PICU stay. Furthermore, they question the ability of stored RBCs to improve oxygenation in critically ill children.
Given that 15-23% of Pediatric PICU patients receive at least one transfusion, and that nearly one in two pediatric patients who stay longer than 48 hours receive a blood transfusion, these findings are relevant as they document NISHOTs (non-infectious serious hazards of transfusion) which are increasingly reported in the literature.
How this translates to other pediatric populations which receive blood transfusions, such as trauma and major surgery, remains to be determined. Certainly these NISHOT complications, which include TRALI (transfusion-related acute lung injury), TACO (transfusion-related acute circulatory overload), and TRIM (transfusion-related immune-modulation) are likely under recognized and under reported.
Susan M Goobie, MD, FRCPC
Department of Anesthesiology, Peri-operative and Pain Medicine
Boston Children’s Hospital