Transfusion de concentré globulaire en réanimation pédiatrique

Objective: To determine the incidence rate and the indications of red blood cell (RBC) transfusion in a pediatric intensive care unit (PICU).

Patients and methods: A prospective observational cohort study of 303 consecutive patients was carried out in a multidisciplinary PICU in a tertiary care university hospital. All the patients were monitored daily over a three-month period. No interventions were done.

Primary outcome measure: Reasons for and number of RBC transfusions.

Secondary outcome measure: Comparison of the data between the group of transfused patients versus non-transfused patients.

Results: Forty-five patients (5%) received one to 33 RBC transfusions, for a total of 103 transfusions. RBC transfusion was given according to the medical team and also clinical and paraclinical parameters, for the following reasons: respiratory failure ($\text{84}\text{103}$), active bleeding ($\text{67}\text{103}$), hemodynamic instability ($\text{50}\text{103}$), blood lactate level > 2 mmol/L ($\text{10}\text{103}$), or to increase oxygen delivery ($\text{6}\text{103}$). In many cases, more than one reason was specified, but in seven cases, no specific reason was provided. The mean hemoglobin concentration before transfusion was 8.1 ± 1.9 g/dL (median: 7.9; range: 3.8 to 17.1 g/dL). The mean PRISM III score at entry was 9 ± 5. The following data were significantly higher in the transfused group: antecedent of neoplasm or cardiovascular disease, hematologic or cardiovascular disease as primary affection, multiple organ dysfunction syndrome, PRISM III score at entry, death and length of stay in PICU.

Conclusion: In this PICU, 15% of the patients received at least one RBC transfusion. In most instances, the indication for a RBC transfusion was to support a respiratory failure. In 7% of the cases, there was no reported indication to explain the transfusion. Morbidity and mortality rates were higher among transfused patients.