Red blood cell (RBC) transfusion is a common and important supportive measure in pediatric
intensive care units (PICU). Anemia, defined as hemoglobin concentrations below the
normal range for age, occurred in 36.7% of critically ill children treated in a multidisciplinary
PICU [
[1]
]. The development of anemia resulted in 15% of critically ill children receiving a
transfusion during their PICU stay [
[2]
]. This article highlights specific concerns in regards to anemia and transfusion in
critically ill children. It focuses on differences in the characteristics of patients
and disease state, adaptive responses to anemia, and clinical studies that have evaluated
transfusion practice in this population.To read this article in full you will need to make a payment
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References
- Clinically significant upper gastrointestinal bleed acquired in a pediatric intensive care unit: a prospective study.Pediatrics. 1998; 102: 933-938
- Pratique de transfusion de concentré globulaire en réanimation pédiatrique: une étude descriptive prospective.Réanimation Urgences. 2000; 9: 339-344
- Human cardiovascular and metabolic response to acute, severe isovolemic anemia.JAMA. 1998; 279: 217-221
- Oxygen consumption is independent of increases in oxygen delivery by dobutamine in septic patients who have normal or increased plasma lactate.Am Rev Respir Dis. 1993; 147: 25-31
- Review of physiologic mechanisms in response to anemia.Can Med Assoc J. 1997; 156: S27-S40
- Lacroix J Gauthier M Beaufils F Urgences et soins intensifs pédiatriques. Les Presses de l'Université de Montréal et Doin, Montréal (Canada)1994
- Myocardial, erythropoietic, and metabolic adaptations to anemia of prematurity in infants with bronchopulmonary dysplasia.J Pediatr. 1998; 132: 630-634
- Myocardial, erythropoietic, and metabolic adaptations to anemia of prematurity.J Pediatr. 1994; 125: 278-282
- The effect of blood transfusion on the hemoglobin oxygen dissociation curve of very early preterm infants during the first week of life.Semin Perinatol. 2002; 26: 411-415
- Blood viscosity during the neonatal period: the role of plasma and red blood cell type.J Pediatr. 1982; 100: 449-453
- WB Saunders Company, Philadelphia1998: 1-1914 Nathan and Oski's hematology of infancy and childhood. 5th edition.
- Circulating erythropoietin and interleukin-6 concentrations increase in critically ill children with sepsis and septic shock.Crit Care Med. 1996; 24: 1455-1459
- Blunted erythropoietic response to anemia in multiply traumatized patients.Crit Care Med. 2001; 29: 743-747
- The Pediatric Risk of Mortality III-Acute Physiology Score (PRISM III-APS): a method of assessing physiologic instability for pediatric intensive care unit patients.J Pediatr. 1997; 131: 575-581
- Quality of life before intensive care unit admission and its influence on resource utilization and mortality rate.Crit Care Med. 2001; 29: 1701-1709
- Alimentations entérale et parentérale.in: Lacroix J Gauthier M Beaufils F Urgences et soins intensifs pédiatriques. Les Presses de l'Université de Montréal et Doin, Montréal (Canada)1994: 103-124
- Factors influencing the individual effects of blood transfusion on oxygen delivery and oxygen consumption.Crit Care Med. 1999; 27: 2194-2200
- Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction.Crit Care Med. 1990; 18: 1316-1319
- Effect of blood transfusion on oxygen consumption in pediatric septic shock.Crit Care Med. 1990; 18: 1087-1091
- Consensus conference. Perioperative red blood cell transfusion.JAMA. 1988; 260: 2700-2703
- Risk of infection after penetrating abdominal trauma.N Engl J Med. 1984; 311: 1065-1070
- Improved renal allograft survival after blood transfusion: a nonspecific, erythrocyte-mediated immunoregulatory process?.Lancet. 1979; 1: 20-22
- Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusions.Blood. 1984; 64: 308-310
- Abnormal T-lymphocyte subpopulations associated with transfusions of blood-derived products.Lancet. 1983; 1: 991-992
- Perioperative transfusions associated with colorectal cancer surgery: clinical judgment versus the hematocrit.World J Surg. 1986; 10: 516-521
- Red for danger: blood transfusion and colorectal cancer.BMJ. 1985; 291: 841-842
- Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient.Crit Care Med. 2002; 30: 2249-2254
- Epidemiology of sepsis and multiple organ dysfunction syndrome in children.Chest. 1996; 109: 1033-1037
- Cell-mediated immunity in severely head-injured patients: the role of suppressor lymphocytes and serum factors.J Neurosurg. 1992; 77: 694-699
- Host defense in blunt trauma: inter-relationships of kinetics of anergy and depressed neutrophil function, nutritional status, and sepsis.J Trauma. 1980; 20: 833-841
- Postinjury multiple organ failure: a bimodal presentation.J Trauma. 1996; 40: 501-510
- An outbreak of necrotizing enterocolitis association with transfusion of packed red blood cells.Am J Epidemiol. 1987; 126: 1165-1172
- Guidelines for red blood cell and plasma transfusions for adults and children.Can Med Assoc J. 1997; 156: S1-S24
- Retrolenticular fibroplasia and exchange transfusions.Union Med Can. 1976; 105: 1666-1668
- Effect of stored-blood transfusion on oxygen delivery in patients with sepsis.JAMA. 1993; 269: 3024-3029
- Oxygen consumption–oxygen delivery relationship in children.J Pediatr. 1993; 123: 208-214
- Acute hemodynamic effects of increasing hemoglobin concentration in children with a right to left ventricular shunt and relative anemia.J Am Coll Cardiol. 1985; 5: 357-362
- The pathophysiology of disorders of oxygen transport in the infant.Curr Probl Pediatr. 1981; 11: 50p
- Blood transfusion for severe anaemia in children in a Kenyan hospital.Lancet. 2002; 359: 494-495
- Effect of blood transfusion on survival among children in a Kenyan hospital.Lancet. 1992; 340: 524-528
- Pediatric red blood cell transfusions increase resource use.J Pediatr. 2003; 142: 123-127
- A multi-center, randomized, controlled clinical trial of transfusion requirements in critical care.N Engl J Med. 1999; 340: 409-417
- Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction.Transfusion. 1997; 37: 678-684
- Cytokine generation in stored, white cell-reduced, and bacterially contaminated units of red cells.Transfusion. 1995; 35: 199-203
- Cytokines in WBC-reduced apheresis PCs during storage: a comparison of two WBC-reduction methods.Transfusion. 2000; 40: 1118-1126
- Cytokine generation in whole blood leukocyte-depleted and temporarily warmed red blood cell concentrates.Vox Sang. 1999; 76: 100-106
- Guidelines for auditing pediatric blood transfusion practices.Am J Dis Child. 1991; 145: 787-796
- Guidelines for blood utilization review.Transfusion. 1994; 34: 438-448
- Perioperative management of patients with congenital heart disease: a multidisciplinary approach.in: Nichols D.G Cameron D.E Greeley W.J Lappe D.G Ungerleider R.M Wetzel R.C Critical heart disease in infants and children. Mosby, St-Louis (MO)1995: 553-579
- Consequence of chronic hypoxemia and pulmonary vascular disease.in: Garson Jr, A.J Bricker J.T Fisher D.J Neish S.R The science and practice of pediatric cardiology. Williams & Wilkins, Baltimore (MD)1998: 2261-2272
- WB Saunders Company, Philadelphia1994: 1-506 Cardiac surgery of the neonate and infant.
- Intensive care.in: Emmanouilides G.C Riemenschneider T.A Allen H.D Gutsesell H.P Heart disease in infants, children, and adolescents. Williams & Wilkins, Baltimore (MD)1995: 398-439
- Cardiac operation for congenital heart disease in children of Jehovah's Witnesses.J Thorac Cardiovasc Surg. 1985; 89: 914-920
- Total bloodless open heart surgery in the pediatric age group.Circulation. 1984; 70: 1-30
- Packed red blood cell transfusions for critically ill pediatric patients: when and for what conditions?.J Pediatr. 2003; 142: 95-97
- Survey of transfusion practices in pediatric intensive care units.Pediatr Crit Care Med. 2002; 3: 335-340
- Pediatric risk of mortality (PRISM) score.Crit Care Med. 1988; 16: 1110-1116
- Transfusion-associated graft versus host disease.Pediatr Crit Care Med. 2002; 3: 57-62
- Erythropoietin for critically ill children.Pediatr Crit Care Med. 2003; 4: 123-124
- Use of blood and blood products.in: Rudolph A.M Hoffman J.I.E Rudolph C.D Rudolph's pediatrics. 20th edition. Appleton & Lange, Stanford (CA)1996: 1252-1260
- Blood and blood component transfusions.in: Behrman R.E Kliegman R.M Arvin A.M Nelson textbook of pediatrics. 16th edition. WB Saunders Company, Philadelphia2000: 1499-1500
- Management of pediatric septic shock.in: Holbrook P.R Textbook of pediatric critical care. 1st edition. WB Saunders Company, Philadelphia1993: 114-142
- Organ system considerations that affect anesthetic management.in: Fuhrman B.P Zimmerman J.J Pediatric critical care. 2nd edition. Mosby, St-Louis (MO)1998: 1324-1333
- Choc hémorragique.in: Lacroix J Gauthier M Beaufils F Urgences et soins intensifs pédiatriques. Les Presses de l'Université de Montréal et Doin, Montréal (Canada)1994: 173-187
- Transfusion of blood products: when, why and how.in: Piva J.P Carvalho P.R.A Garcia P.C Terapia intensive pediatria. 5th edition. Medsi, Rio de Janeiro (Brazil)2004 (in press)
- Transfusions with packed red blood cells.in: Blumer J.L A practical guide to pediatric intensive care. 3rd edition. Mosby Year Book, St-Louis (MO)1990: 1001-1007
- Transfusion therapy and apheresis.in: Todres I.D Fugate J.H Critical care of infants and children. 1st edition. Little, Brown & Company, Boston1996: 533-541
- Williams & Wilkins, Baltimore (MD)1996: 1710 Textbook of pediatric intensive care. 3rd edition.
- Red cell transfusion.in: Nathan D.G Orkin S.H Nathan and Oski's hematology of infancy and childhood. 4th edition. WB Saunders Company, Philadelphia1998: 1784-1801
- Normal blood values from birth through adolescence.in: Miller D.R Baehner R.L Miller L.P Blood diseases of infancy and childhood. 7th edition. Mosby, St-Louis (MO)1995: 30-53
- Respiratory physiology in infants and children.in: Motoyama E.K Smith's anesthesia for infants and children. 6th edition. Mosby, St-Louis (MO)1996: 11-67
- Pédiatrie et anesthésie.in: Guay J Martin R Plaud B Précis d'anesthésie et de réanimation. 4th edition. Les Presses de l'Université de Montréal, Montréal (Canada)2001: 505-521
- Blood.in: Oldham K.T Colombani P.M Foglia R.D Surgery of infants and children. 1st edition. Lippincott-Raven, Philadelphia1997: 309-320
- Perioperative haemotherapy: I. Indications for blood component transfusion.Can J Anesth. 1992; 39: 695-707
- Groupe de travail d'experts. Lignes directrices sur la transfusion de globules rouges et de plasma aux adultes et aux enfants.Can Med Assoc J. 1997; 156: S1-S26
- Surgical implications of hematologic disease.in: O'Neill J.A Rowe M.I Grosfeld J.L Foukalsrud E.W Coran A.G Pediatric surgery. 5th edition. Mosby, St-Louis (MO)1998: 157-170
- Lippincott and Williams & Wilkins, Philadelphia1999: 2368 Oski's pediatrics principles and practice. 3rd edition.
- Blood transfusion and component therapy.in: Gregory G.A Pediatric anesthesia. 4th edition. Churchill Livingstone, New York2002: 117-144
Article info
Footnotes
☆This work was supported by Grant No. 84300 from the Canadian Institutes of Health Research. Dr. Desmet received a Fellowship Award from the Fondation de l'Hôpital Sainte-Justine.
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© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.