Critically ill children: to transfuse or not to transfuse packed red blood cells, that is the question.

OBJECTIVES

This article summarizes the current data on packed red blood cell transfusion in the pediatric intensive care unit setting to help providers make evidence-based decisions regarding packed red blood cell transfusions.

DATA SOURCES

Review of the literature, including PubMed, citations from relevant articles, and some articles that have been particularly relevant in adult critical care practice regarding packed red blood cell transfusion.

CONCLUSIONS

The use of packed red blood cell transfusions is common in the pediatric intensive care unit setting. However, until recently there have been little data to guide providers in this practice. Studies in adult intensive care units have shown less favorable outcomes in patients who received packed red blood cell transfusions. This has led to renewed questioning of the practice of packed red blood cell transfusion in critically ill pediatric patients. New data indicate that using a hemoglobin transfusion threshold of >7 g/dL does not yield improved outcomes. Furthermore, smaller studies have suggested that pediatric intensive care unit patients may be at an increased risk for morbidity and mortality when undergoing transfusion.