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Multicenter Study
. 2025 Oct 1;26(10):e1231-e1241.
doi: 10.1097/PCC.0000000000003805. Epub 2025 Aug 7.

Red Cell Transfusion During Pediatric Intensive Care: A 28-Day Point Prevalence Study in Three European Countries in 2023

Laura Butragueño-Laiseca  1   2   3   4 , Samiran Ray  5 , Avishay Sarfatti  6 , Simon J Stanworth  7 , Roi Campos Rodríguez  8 , Ana Gómez-Zamora  9 , Alexandra Hernández Yuste  10 , Isabel Benítez Gómez  11 , Gema de Lama Caro-Patón  12 , Chiara Giorni  13 , Elisabetta Lampugnani  14 , Marco Daverio  15 , Fabrizio Chiusolo  16 ; European PEdiatric TRAnsfusion Practices in PICU (E-PETRA) Investigators and the United Kingdom Pediatric Critical Care Society Study Group (PCCS-SG)
Collaborators, Affiliations
Multicenter Study

Red Cell Transfusion During Pediatric Intensive Care: A 28-Day Point Prevalence Study in Three European Countries in 2023

Laura Butragueño-Laiseca et al. Pediatr Crit Care Med. .

Abstract

Objectives: To describe the prevalence of RBC transfusion in children admitted to PICUs in three European countries and to determine hemoglobin threshold, triggers, and outcomes for transfusions.

Design: International 4-week point prevalence study in 2023.

Setting: Forty-four PICUs across Spain, the United Kingdom, and Italy.

Patients: PICU patients 1 month to 17 years old receiving RBC transfusion.

Interventions: None.

Measurements and main results: During four prespecified 7-day blocks (from March 2023 to July 2023), 348 of 2713 patients (12.8%) received at least one RBC transfusion, accounting for 527 transfusions. The proportion of patients receiving RBC transfusion in Italy, the United Kingdom, and Spain was 17.3% (66/382), 13.9% (166/1195), and 10.2% (116/1136), respectively. The primary indication for transfusion in the 527 transfusion events was hemoglobin level (54.6%), followed by bleeding (10.6%), cardiovascular instability (10.5%), and extracorporeal support (10.1%). In 45.1% of RBC transfusions, there was no other physiologic trigger apart from hemoglobin. The median (interquartile range [IQR]) hemoglobin level before transfusion was 8.3 g/dL (IQR, 7.2-9.9 g/dL), with median values varying significantly among Spain, the United Kingdom, and Italy, respectively, 7.8 vs. 8.6 vs. 8.9 g/dL ( p < 0.001). When excluding cardiac patients, overall median hemoglobin threshold was 7.4 g/dL (IQR, 6.8-8.6 g/dL) and was comparable across the three countries ( p > 0.05). The overall 28-day PICU mortality in 348 patients receiving transfusions was 10.7%. The number of transfusions was associated with mortality, even after adjusting for reason for admission and admission Pediatric Index of Mortality score.

Conclusions: In 44 European PICUs in 28 days during 2023, 12.8% of critically ill children received one or more RBC transfusions during their PICU stay. Hemoglobin level was the primary determinant for transfusion, often exceeding the recommended 7.0 g/dL threshold. Other clinical triggers are rarely considered. Defining hemoglobin thresholds and adopting a goal-directed transfusion strategies may optimize clinical transfusion practices.

Keywords: blood transfusion; children; critical illness; pediatric intensive care units; red blood cells.

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Conflict of interest statement

Dr. Ray received funding from the U.K. Engineering and Physical Sciences Council, the U.K. National Institute of Health Research, the U.K. Research and Innovation/Horizon Europe, and La Roche; he received support for article research from the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. Dr. Gómez-Zamora received funding from Aerogen Pharma. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Valentine SL, Bembea MM, Muszynski JA, et al.; Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI): Consensus recommendations for RBC transfusion practice in critically ill children from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med. 2018; 19:884–898
    1. Lacroix J, Hébert PC, Hutchison JS, et al.; TRIPICU Investigators: Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007; 356:1609–1619
    1. Carson JL, Stanworth SJ, Dennis JA, et al.: Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021; 12:CD002042
    1. Doctor A, Cholette JM, Remy KE, et al.; Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI): Recommendations on RBC transfusion in general critically ill children based on hemoglobin and/or physiologic thresholds from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med. 2018; 19:S98–S113
    1. Downey LA, Goobie SM: Perioperative pediatric erythrocyte transfusions: Incorporating hemoglobin thresholds and physiologic parameters in decision-making. Anesthesiology. 2022; 137:604–619

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