Red Blood Cell Transfusion Practices in PICU: To be liberal or not to be!

Background / Aim: To evaluate red blood cell (RBC) transfusion practices in a pediatric intensive care unit (PICU) and identify factors predicting transfusion needs. Methods A retrospective observational study was conducted on children (0–18 years) admitted to a tertiary academic PICU from January 2015 to December 2021. Demographic data, clinical parameters, and transfusion events were analyzed using chi-square tests, logistic regression, and Kaplan-Meier estimation. Results Of 2011 patients, 27.7% (n = 558) received at least one RBC transfusion, with a median pre-transfusion hemoglobin level of 8.9 g/dL [IQR: 8.1–9.6]. Anemia was present in 47.59% (n = 957) at admission, with 48.17% (n = 461) requiring transfusion. Younger age (0–2 years: OR 2.22, 95% CI 1.9–2.61) and lower weight-for-age Z scores (severely underweight: OR 1.64, 95% CI 1.2–2.24) were associated with increased transfusion likelihood. Multiple transfusions were linked to higher mortality risk (OR 15.16, 95% CI 8.0-28.73, p < 0.001). Conclusion RBC transfusion practices in the PICU are complex and often lean towards more liberal strategies. Personalized approaches that incorporate patient-specific factors are essential to optimize transfusion decisions. Persistent anemia at discharge and its long-term impact warrant further investigation.