All our cells need oxygen for their metabolism. Oxygen delivery is dependant on cardiac output, hemoglobin and arterial blood saturation. Therefore, red blood cells (RBC) transfusions could seem to be the best therapy to increase oxygen delivery in critically ill children. However, RBC transfusions are associated with an increased morbidity and mortality. This might be due to the storage lesions, which decrease the stored RBC’s ability to transport oxygen in the microcirculation, and modify their immunomodulative properties. Therefore, one must carefully select the patients for whom the benefits will be greater than the risks.
For unstable critically ill children, it is usually recommended to transfuse for a Hb threshold of 100 g/l, after correcting the cardiac output.
For critically ill children, it is recommended to transfuse for a Hb threshold of 70 g/L. This threshold has also been validated for septic patients as well as surgery and cardiac surgery patients. For single-ventricle physiology patients, it seems reasonable to transfuse RBC units for a threshold of 90 g/L. For neonates, a higher threshold is used (Hb 120–140 g/L if FiO2 > 40%, Hb 100 g/L if FiO2 < 40%, Hb 70–80 g/L for asymptomatic infants). Lower thresholds have been proposed for chronically anemic children (Hb 50 g/L).
RBC transfusions are a common treatment, but one must be aware of the associated risks and the appropriate transfusion indications, in order to prevent unnecessary morbidity and mortality.
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