Helen DeVos Children's Hospital, Grand Rapids, Michigan 49503, USA.
J Hosp Med. 2010 Sep;5(7):410-3. doi: 10.1002/jhm.700.
Children with pneumonia may develop parapneumonic effusion (PNE). The associated inflammatory process and nutritional compromise can blunt erythropoesis. Traditional treatment for these children with PNE includes repeated phlebotomy and surgical intervention, resulting in ongoing blood losses. Blood transfusions used to treat acquired anemia are associated with multiple complications.
This study evaluated the effect of hospitalists' implementation of blood conservation guidelines (BCG) on the incidence of anemia and transfusion requirements in children with PNE.
Retrospective cohort study of hospitalized children with PNE.
University affiliated Children's Hospital.
Children who were admitted to the hospital with PNE and managed using BCG (Group I) were compared to simultaneous no intervention group (S) and historical no intervention group (H). Group (I) and (S) were admitted from year 2000 to 2004 and the Group (H) were admitted from year 1997 to 1999.
Phlebotomy frequency and volume, measured hemoglobin (Hgb) levels, and the need for red blood transfusions.
Children in the BCG group (n = 24) compared to simultaneous no intervention group (n = 28) and historical no intervention group (n = 29) had lesser phlebotomy volumes (14 ± 8, 18 ± 14 and 69 ± 66 mL; P = 0.001), trend toward lesser Hgb drop (1.7 ± 1.4, 2.1 ± 1.2 and 2 ± 1.4 gm%; P ≤ 0.37), and lesser incidence of transfusion (8%, 18% and 31%; P = 0.11). Transfused children were younger (3.5 ± vs. 6.4 ± 4 years; P = 0.001) and had lower initial Hgb (9.9 ± 1 vs. 11.4 ± 1 gm%; P = 0.001), more phlebotomy (5.9 ± 7 vs. 1.1 ± 1 mL/kg., P = 0.001), longer hospitalization (18.7 ± 5 vs. 11.1 ± days; P = 0.001), and slightly higher (pediatric risk of mortality [PRISM]) scores (3.4 ± 5.7 vs. 1.6 ± 2.7; P = 0.25).
Implementing BCG lowers phlebotomy losses and the need for transfusion.
患有肺炎的儿童可能会出现肺炎旁胸腔积液（PNE）。相关的炎症过程和营养不足会抑制红细胞生成。这些患有 PNE 的儿童的传统治疗包括反复放血和手术干预，导致持续失血。用于治疗获得性贫血的输血与多种并发症有关。
本研究评估了主治医生实施血液保护指南（BCG）对患有 PNE 的儿童贫血发生率和输血需求的影响。
患有 PNE 的住院儿童的回顾性队列研究。
大学附属儿童医院。
患有 PNE 并使用 BCG 治疗的住院儿童（I 组）与同时无干预组（S）和历史无干预组（H）进行比较。I 组和 S 组于 2000 年至 2004 年入院，H 组于 1997 年至 1999 年入院。
放血频率和体积、测量血红蛋白（Hgb）水平以及输血需求。
与同时无干预组（n=28）和历史无干预组（n=29）相比，BCG 组（n=24）的放血量较少（14±8、18±14 和 69±66 mL；P=0.001），血红蛋白下降趋势较小（1.7±1.4、2.1±1.2 和 2±1.4 gm%；P≤0.37），输血发生率较低（8%、18%和 31%；P=0.11）。接受输血的儿童年龄较小（3.5±vs.6.4±4 岁；P=0.001），初始血红蛋白较低（9.9±1 vs.11.4±1 gm%；P=0.001），放血量较大（5.9±7 vs.1.1±1 mL/kg，P=0.001），住院时间较长（18.7±5 vs.11.1±天；P=0.001），儿科死亡风险评分（PRISM）略高（3.4±5.7 vs.1.6±2.7；P=0.25）。
实施 BCG 可降低放血损失和输血需求。
