Transfusion Decision Making in Pediatric Critical Illness

Pediatr Clin North Am. 2017 Oct;64(5):991-1015. doi: 10.1016/j.pcl.2017.06.003.

Abstract

Transfusion decision making (TDM) in the critically ill requires consideration of: (1) anemia tolerance, which is linked to active pathology and to physiologic reserve, (2) differences in donor RBC physiology from that of native RBCs, and (3) relative risk from anemia-attributable oxygen delivery failure vs hazards of transfusion, itself. Current approaches to TDM (e.g. hemoglobin thresholds) do not: (1) differentiate between patients with similar anemia, but dissimilar pathology/physiology, and (2) guide transfusion timing and amount to efficacy-based goals (other than resolution of hemoglobin thresholds). Here, we explore approaches to TDM that address the above gaps.

Keywords: Anemia; Precision medicine; Systems dynamics; Transfusion decision making.

Publication types

  • Review

MeSH terms

  • Child
  • Clinical Decision-Making / methods*
  • Critical Care / methods*
  • Critical Care / standards
  • Critical Illness / therapy*
  • Decision Support Techniques
  • Erythrocyte Transfusion* / adverse effects
  • Erythrocyte Transfusion* / methods
  • Erythrocyte Transfusion* / standards
  • Humans
  • Pediatrics
  • Precision Medicine
  • Systems Analysis