Report by

D G Markhorst, Paediatric Intensive Care Unit, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; dg.markhorst@vumc.nl

M C J Kneyber, Paediatric Intensive Care Unit, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

Joseph, a 4-year-old boy with septic shock, lactic acidosis and multi-organ failure has been admitted to the paediatric intensive care unit. Mechanical ventilation, vaso-active support and renal replacement therapy (CVVHD) are initiated. His haemoglobin level is 8.8 g/dl (5.5 mmol/l).

The senior consultant decides to order a red cell transfusion in order to optimise oxygen delivery, but the junior fellow argues that there is no evidence that …