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Fewer Transfusions OK in Critically Ill Children

Reducing transfusion exposure by setting lower hemoglobin limits does not increase adverse outcomes

WEDNESDAY, April 18 (HealthDay News) -- A strategy of using a lower hemoglobin threshold before the infusion of red blood-cells can decrease transfusions without increasing adverse outcomes in stable, critically ill children, according to a report in the April 19 issue of the New England Journal of Medicine.

Jacques Lacroix, M.D., of Université de Montréal, Québec, Canada, and colleagues randomly assigned 637 stable but critically ill children with hemoglobin concentrations below 9.5 g/dL to infusion of leukocyte-reduced packed red cells. In one group, they used a restrictive strategy, setting a threshold of 7 g/dL before transfusion, and, in the other, they used a liberal strategy, with a threshold of 9.5 g/dL.

Patients in the restrictive strategy group received 44 percent fewer transfusions and had hemoglobin concentrations of 2.1 g/dL lower than the liberal strategy group. In fact, 54 percent in the restrictive group did not receive any transfusions compared with 2 percent in the liberal group. About 12 percent in each group had multiple organ dysfunction syndrome, and 14 patients died in each group.

"A transfusion trigger of 7.0 g per deciliter for most critically ill adults and children appears to be appropriate," according to Howard L. Corwin, M.D., of Lebanon, N.H., and a colleague in an accompanying editorial. "Red-cell transfusion should no longer be regarded as 'may help, will not hurt' but, rather, should be approached as 'first, do no harm.' "

Some of the authors had received support from Johnson & Johnson/Ortho Biotech, Novo Nordisk, Amgen, Baxter, Xoma, or Eli Lilly.

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