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Intensivists should think carefully before giving red cell transfusions to critically ill children, say researchers. A cautious policy that triggers a transfusion only when the haemoglobin concentration drops to 70 g/l (7 g/dl) or below looked safe in a recent trial, and substantially reduced children's exposure to potentially harmful blood products.
The trial comprised 637 children who were critically ill but stable. All were in paediatric intensive care units. One group had a transfusion threshold of 70 g/l, whereas controls were given red cells when their haemoglobin concentration fell to 95 g/l.
Twelve per cent of both groups (38/320 v 39/317) developed new or progressive multiorgan failure. Fourteen children (4%) died in each group. Restricting transfusions made no difference to infection rates, organ dysfunction scores, or duration of illness. But it did reduce children's exposure to red cells by 44% (0.9 v 1.7 transfusions per child). Adverse events were closely matched.
The trial was designed specifically to find out if the two strategies were equally safe, and the authors are confident that more judicious use of leucocyte reduced red cells does stable children no harm. The picture may be different for premature babies or children who are hypoxic, haemodynamically unstable, or bleeding.