The use of physiologic markers of anemia intolerance to guide transfusion practice in pediatric intensive care units: an international survey

Abstract Objectives To explore how red blood cell (RBC) transfusion practice of pediatric intensivists is modulated by physiologic markers of anemia intolerance, in addition to the hemoglobin (Hb) concentration. Background Most research to date has tested transfusion policies based on Hb threshold alone. Use of physiologic parameters to guide RBC transfusion in pediatric intensive care units (PICU) is not well described. Methods/materials Scenario-based self-administered survey among pediatric intensivists in tertiary-care PICUs in Belgium, Canada, France, Japan and United Kingdom. Pediatric intensivists were approached through national networks and by e-mail. Five case scenarios were developed for non-bleeding critically ill children who were hemodynamically stable at baseline. Respondents were asked to select a Hb threshold for each scenario and indicate how alternative thresholds of different physiologic parameters would modify their baseline hemoglobin (Hb) threshold. Results One hundred thirty-two participant responses were received (response rate 56%). Findings indicate that pediatric intensivists do incorporate physiologic parameters when deciding to transfuse RBCs. The most significant determinants of RBC transfusion, in addition to Hb threshold, were baseline co-morbidity (cyanotic cardiac vs. other patients), ScvO 2 , blood lactate, increasing inotrope or vasoactive-inotropic score, and a drop ≥ 3 g/dL in the Hb concentration. Conclusions Stated transfusion practice by pediatric intensivists involves physiologic parameters, in addition to Hb concentration. Both static and dynamic parameters (single value and trend over time) were considered by clinicians. The striking variation in practice pattern reported strongly supports the need for further studies that would identify and assess the impact of physiologic biomarkers for RBC transfusion in PICU.