Red blood cell transfusion thresholds in pediatric septic patients

Abstract

Introduction: In children with severe sepsis or septic shock, the optimal red blood cell (RBC) transfusion threshold is unknown. We analyzed the subgroup of patients with sepsis in the TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units) study in order to determine the impact of a restrictive versus liberal transfusion strategy on clinical outcome. Methods: This study is a subgroup analysis of a prospective multicenter randomized controlled trial (TRIPICU). One hundred and thirty-seven stabilized critically ill children (mean systemic arterial pressure >2 SD below normal mean for age and cardiovascular support not increased for at least 2 hours before enrolment), with a hemoglobin <0.01). No clinically significant differences were found for the occurrence of new or progressive multiple organ dysfunction syndrome (18.8% vs. 19.1%; P = 0.97), for PICU length of stay (P = 0.74) or PICU mortality (P = 0.44) in the restrictive versus liberal group. Conclusions: In this subgroup analysis of stable septic children, we found no evidence that a restrictive red-cell transfusion strategy, as compared with a liberal one, increased the rate of new or progressive MODS. On the other hand, a restrictive transfusion threshold significantly reduced exposure to blood products. Our data suggest that a hemoglobin level of 7 g/dl may be safe for stabilized septic children but further studies are required to support this recommendation.