Department of Anesthesiology, Institute of Pediatric Anesthesia, Cincinnati Children's Research Foundation, Cincinnati, OH, USA. George.istaphanouscchmc.org
Pediatr Crit Care Med. 2011 Mar;12(2):174-83. doi: 10.1097/PCC.0b013e3181e30d09.
To review the pathophysiology of anemia, as well as transfusion-related complications and indications for red blood cell (RBC) transfusion, in critically ill children. Although allogeneic blood has become increasingly safer from infectious agents, mounting evidence indicates that RBC transfusions are associated with complications and unfavorable outcomes. As a result, there has been growing interest and efforts to limit RBC transfusion, and indications are being revisited and revamped. Although a so-called restrictive RBC transfusion strategy has been shown to improve morbidity and mortality in critically ill adults, there have been relatively few studies on RBC transfusion performed in critically ill children.
Published literature on transfusion medicine and outcomes of RBC transfusion. STUDY SELECTION, DATA EXTRACTION, AND SYNTHESIS: After a brief overview of physiology of oxygen transportation, anemia compensation, and current transfusion guidelines based on available literature, risks and outcomes of transfusion in general and in critically ill children are summarized in conjunction with studies investigating the safety of restrictive transfusion strategies in this patient population.
The available evidence does not support the extensive use of RBC transfusions in general or critically ill patients. Transfusions are still associated with risks, and although their benefits are established in limited situations, the associated negative outcomes in many more patients must be closely addressed. Given the frequency of anemia and its proven negative outcomes, transfusion decisions in the critically ill children should be based on individual patient's characteristics rather than generalized triggers, with consideration of potential risks and benefits, and available blood conservation strategies that can reduce transfusion needs.
综述危重症患儿贫血的病理生理学，以及输血相关并发症和红细胞（RBC）输血的适应证。尽管异体血液在病原体方面已变得越来越安全，但越来越多的证据表明 RBC 输血与并发症和不良结局相关。因此，人们越来越关注并努力限制 RBC 输血，适应证也在不断重新审视和调整。虽然所谓的限制性 RBC 输血策略已被证明可改善危重症成人的发病率和死亡率，但在危重症儿童中进行的 RBC 输血研究相对较少。
关于输血医学和 RBC 输血结果的已发表文献。
研究选择、资料提取和综合：简要概述氧气输送、贫血代偿和基于现有文献的当前输血指南的生理学之后，结合研究调查限制性输血策略在该患者人群中的安全性，总结了一般输血和危重症儿童输血的风险和结果。
现有证据不支持广泛使用 RBC 输血，一般或危重症患者均如此。输血仍然存在风险，尽管在有限的情况下已证实其具有益处，但在更多患者中存在的相关负面结果必须密切关注。鉴于贫血的发生率及其已证实的不良结局，危重症患儿的输血决策应基于患者个体的特征，而不是普遍的触发因素，应考虑潜在的风险和益处，以及可减少输血需求的现有血液保护策略。
