Project Description

Hematological complications such as anemia, bleeding, thrombocytopenia or coagulopathy are very frequent in pediatric intensive care units (PICU) and associate high rates of morbimortality in the critically ill patient1-4. As a consequence, transfusion of blood-products in an attempt to improve these alterations is a very common practice in PICU (up to 50% of patients receive a red blood cell transfusion)5,6. However, there is lack of sufficient evidence in transfusions decision-making in PICU and a considerable number of units do not have a protocolized practice. Therefore, transfusion practice can considerably vary across institutions and countries.

Although blood transfusions can be lifesaving in some circumstances, blood products have been identified as an independent risk factor of morbimortality; increasing the risk of death, nosocomial infections, length of stay or length of mechanical ventilation7-9. Moreover, the Joint Commission recently identified transfusion as the second most overused product with patients’ safety concerns. Therefore, patient blood management strategies and guidelines are gaining great importance in recent years10.

Recent guidelines recommend a restrictive versus liberal transfusion strategy for red blood cells in PICU, with hemoglobin threshold <7 g/dl in most ICU patients11-15. However, there is lack of evidence in unstable patients or specific PICU subpopulation patients11. Besides, in transfusion decision-making, not only hemoglobin threshold must be considered; other physiological triggers (symptoms, signs, physiological markers, laboratory results) must be taking into account16,17. Nevertheless, there is also lack of evidence in the use and utility of different physiological triggers.

The optimal transfusion strategy in PICU also remains unknown for other blood products such as platelets and plasma, although recent expert-based guidelines recommend also a restrictive transfusion policy18-21.

This study was designed with the aim to define transfusion practice for critically ill children, where lack of evidence is even more pronounced than in adults22. The study will contribute to describe current PICU transfusion practice for all type of blood products. This is the first critically ill children large study that includes different blood products and coagulation factors. The results will be compared with the current international recommendations and might identify areas of improvement.