Hemoglobin thresholds for transfusion in pediatric patients at a large academic health center
Sybil A. Klaus
Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland
First coauthors who contributed equally to this study and manuscript.
Search for more papers by this authorCorresponding Author
Steven M. Frank
Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland
First coauthors who contributed equally to this study and manuscript.
Address correspondence to: Linda M.S. Resar, MD, Department of Medicine, Oncology & Institute for Cellular Engineering, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Room 1015, Baltimore, MD 21205; e-mail: [email protected]; or Steven M. Frank, MD, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore, MD 21287; e-mail: [email protected].Search for more papers by this authorJose H. Salazar
Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorStacy Cooper
Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorLauren Beard
Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorFizan Abdullah
Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorJames C. Fackler
Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorEugenie S. Heitmiller
Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorPaul M. Ness
Department of Pathology (Transfusion Medicine), the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorCorresponding Author
Linda M. S. Resar
Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Departments of Medicine (Hematology), Oncology, & Institute for Cellular Engineering, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Address correspondence to: Linda M.S. Resar, MD, Department of Medicine, Oncology & Institute for Cellular Engineering, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Room 1015, Baltimore, MD 21205; e-mail: [email protected]; or Steven M. Frank, MD, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore, MD 21287; e-mail: [email protected].Search for more papers by this authorSybil A. Klaus
Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland
First coauthors who contributed equally to this study and manuscript.
Search for more papers by this authorCorresponding Author
Steven M. Frank
Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland
First coauthors who contributed equally to this study and manuscript.
Address correspondence to: Linda M.S. Resar, MD, Department of Medicine, Oncology & Institute for Cellular Engineering, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Room 1015, Baltimore, MD 21205; e-mail: [email protected]; or Steven M. Frank, MD, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore, MD 21287; e-mail: [email protected].Search for more papers by this authorJose H. Salazar
Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorStacy Cooper
Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorLauren Beard
Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorFizan Abdullah
Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorJames C. Fackler
Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorEugenie S. Heitmiller
Department of Anesthesiology/Critical Care Medicine, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorPaul M. Ness
Department of Pathology (Transfusion Medicine), the Johns Hopkins Medical Institutions, Baltimore, Maryland
Search for more papers by this authorCorresponding Author
Linda M. S. Resar
Department of Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Departments of Medicine (Hematology), Oncology, & Institute for Cellular Engineering, the Johns Hopkins Medical Institutions, Baltimore, Maryland
Address correspondence to: Linda M.S. Resar, MD, Department of Medicine, Oncology & Institute for Cellular Engineering, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Room 1015, Baltimore, MD 21205; e-mail: [email protected]; or Steven M. Frank, MD, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore, MD 21287; e-mail: [email protected].Search for more papers by this authorAbstract
BACKGROUND
Although prior studies support the use of a hemoglobin (Hb) transfusion trigger of 7 to 8 g/dL for most hospitalized adults, there are few studies in pediatric populations. We therefore investigated transfusion practices and Hb triggers in hospitalized children.
STUDY DESIGN AND METHODS
We performed a historical cohort study comparing transfusion practices in hospitalized children by service within a single academic institution. Blood utilization data from transfused patients (n = 3370) were obtained from electronic records over 4 years. Hb triggers and posttransfusion Hb levels were defined as the lowest and last Hb measured during hospital stay, respectively, in transfused patients. The mean and percentile distribution for Hb triggers were compared to the evidence-based restrictive transfusion threshold of 7 g/dL.
RESULTS
Mean Hb triggers were above the restrictive trigger (7 g/dL) for eight of 12 pediatric services. Among all of the services, there were significant differences between the mean Hb triggers (>2.5 g/dL, p<0.0001) and between the posttransfusion Hb levels (>3 g/dL, p < 0.0001). The variation between the 10th and 90th percentiles for triggers (up to 4 g/dL, p < 0.0001) and posttransfusion Hb levels (up to 6 g/dL, p < 0.0001) were significant. Depending on the service, between 25 and 90% of transfused patients had Hb triggers higher than the restrictive range.
CONCLUSIONS
Red blood cell (RBC) transfusion therapy varies significantly in hospitalized children with mean Hb triggers above a restrictive threshold for most services. Our findings suggest that transfusions may be overused and that implementing a restrictive transfusion strategy could decrease the use of RBC transfusions, thereby reducing the associated risks and costs.
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