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Many Kids in ICU Don't Need Transfusions

Finding could reduce unnecessary procedures and risks to children, experts say

WEDNESDAY, April 18, 2007 (HealthDay News) -- Less may be more when it comes to blood transfusions for children cared for in hospital intensive care units (ICUs), a new study shows.

Researchers say that, in some cases, withholding transfusions from anemic, hospitalized children has no adverse effects and may even reduce risks.

"Most critically ill adults and most critically ill children -- unless there is some pressing indication to transfuse them -- do as well with fewer transfusions as they do with more transfusions," said Dr. Howard L. Corwin, from the Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

Corwin was not involved in the study but wrote an accompanying editorial in the April 19 issue of the New England Journal of Medicine.

Transfusions are given based on the level of hemoglobin, the oxygen-transporting part of the blood. However, doctors still aren't certain as to the optimal hemoglobin level needed before a transfusion. Earlier studies in adults showed that withholding transfusions when hemoglobin levels were low was safe and did not result in adverse effects.

Now, the new study shows that, "in children sick enough to be in the ICU, but who have been stabilized, giving a red blood cell transfusion when the hemoglobin is between 7 and 9.5 grams per deciliter is not better or worse than giving no transfusion," said lead researcher Dr. Jacques R. Lacroix, from Sainte-Justine Hospital in Montreal, Canada.

"This means that we can decrease the number of transfusions," Lacroix said. "For blood banks, this will help relieve the pressure, because we are probably giving too many transfusions," he added.

In the trial, Lacroix's team randomly assigned 637 children cared for in ICUs to different hemoglobin thresholds before transfusions. For one group, the threshold was 7 grams per deciliter, and for the other, it was 9.5 grams per deciliter.

Among children in the 9.5 grams per deciliter group, there were 44 percent fewer transfusions. In fact, 174 patients in that group did not receive a transfusion, compared with just seven patients in the other group.

The frequency of new or progressive cases of a serious complication called multiple-organ dysfunction syndrome was 12 percent in both groups, the researchers reported. In addition, 14 children in each group died. There were no significant differences in other outcomes, including adverse events, between the two groups, the researchers said.

Lacroix believes the results outline the parameters guiding the need for transfusions in pediatric patients.

"Between the upper and lower range of hemoglobin, it is safe to give or not give a red blood cell transfusion," Lacroix said. "Over 7 grams per deciliter, transfusions are probably not so good, but below 7 grams per deciliter, they are warranted," he said.

Corwin agreed that giving kids transfusions solely to increase hemoglobin levels is not justified.

"Giving transfusions to critically ill adults or children with high hemoglobin levels is not necessarily advantageous," he said. "Patients do as well with a more conservative transfusion strategy."

According to Corwin, giving fewer transfusions also cuts down on the risks, such as infection, associated with blood transfusions. "Not giving blood doesn't subject you to risks," Corwin said. "There is less risk, and you are not sacrificing any benefit."

More information

For more information on transfusions, visit the U.S. National Library of Medicine.

SOURCES: Jacques R. Lacroix, M.D., Sainte-Justine Hospital, Montreal, Canada; Howard L. Corwin, M.D., Dartmouth-Hitchcock Medical Center, Lebanon, N.H.; April 19, 2007, The New England Journal of Medicine
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