Red blood cell transfusion practice in children: current status and areas for improvement? A study of the use of red blood cell transfusions in children and infants

Authors

  • Helen V. New,

    Corresponding author
    1. Imperial College Healthcare NHS Trust/NHS Blood and Transplant, London, UK
    2. Royal College of Physicians, London, UK
    3. Royal Brompton Hospital, London, UK
    4. Great Ormond Street Hospital, London, UK
    5. Oxford University Hospitals Trust and University of Oxford, Oxford, UK
    • Address reprint requests to: Helen V. New, Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed St, London W2 1NY, UK; e-mail: helen.new@imperial.nhs.uk.

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  • John Grant-Casey,

    1. Imperial College Healthcare NHS Trust/NHS Blood and Transplant, London, UK
    2. Royal College of Physicians, London, UK
    3. Royal Brompton Hospital, London, UK
    4. Great Ormond Street Hospital, London, UK
    5. Oxford University Hospitals Trust and University of Oxford, Oxford, UK
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  • Derek Lowe,

    1. Imperial College Healthcare NHS Trust/NHS Blood and Transplant, London, UK
    2. Royal College of Physicians, London, UK
    3. Royal Brompton Hospital, London, UK
    4. Great Ormond Street Hospital, London, UK
    5. Oxford University Hospitals Trust and University of Oxford, Oxford, UK
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  • Andrea Kelleher,

    1. Imperial College Healthcare NHS Trust/NHS Blood and Transplant, London, UK
    2. Royal College of Physicians, London, UK
    3. Royal Brompton Hospital, London, UK
    4. Great Ormond Street Hospital, London, UK
    5. Oxford University Hospitals Trust and University of Oxford, Oxford, UK
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  • Sylvia Hennem,

    1. Imperial College Healthcare NHS Trust/NHS Blood and Transplant, London, UK
    2. Royal College of Physicians, London, UK
    3. Royal Brompton Hospital, London, UK
    4. Great Ormond Street Hospital, London, UK
    5. Oxford University Hospitals Trust and University of Oxford, Oxford, UK
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  • Simon J. Stanworth

    1. Imperial College Healthcare NHS Trust/NHS Blood and Transplant, London, UK
    2. Royal College of Physicians, London, UK
    3. Royal Brompton Hospital, London, UK
    4. Great Ormond Street Hospital, London, UK
    5. Oxford University Hospitals Trust and University of Oxford, Oxford, UK
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  • Supported by the National Comparative Audit of Blood Transfusion, NHS Blood and Transplant.

Abstract

Background

Patterns of red blood cell (RBC) transfusion are less well understood for children than adults. This study was undertaken to document current pediatric practice, to identify specific areas for improving patient care and safety.

Study Design and Methods

All UK hospitals were invited to participate. All children less than 18 years old admitted and receiving a RBC transfusion during a 3-month period in 2009 were eligible for inclusion.

Results

A total of 160 of 247 (65%) sites treating children or neonates responded; 119 provided data on 1302 pediatric patients transfused in nonneonatal wards. A total of 74% of patients received a single RBC transfusion during their admission. More than half (53%) of recipients had a hematologic or oncologic underlying diagnosis, and 33% were on general pediatric wards. The median pretransfusion hemoglobin (Hb) level was 7.9 g/dL (interquartile range [IQR], 6.9-9.4 g/dL), varying by location and diagnosis. The median volume prescribed was 15 mL/kg (IQR, 11.8-19.2 mL/kg). Prescribing by units instead of milliliters was recorded for 493 of 1264 (39%) of transfusions. For 734 of 1302 (56%) where Hb levels were available within 2 days between pre- and posttransfusion Hb, the median transfusion increment was 2.8 g/dL (IQR, 1.4-3.9 g/dL).

Conclusion

This study of UK pediatric RBC transfusion practice has demonstrated significant variation in pretransfusion Hb, frequent prescribing in units rather than milliliters, and a high proportion of single transfusions during admissions. Future education and research should target transfusion triggers and prescription volumes for children in all clinical areas.

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