Jurnal Anak ANEMIA

8/10/2019 Jurnal Anak ANEMIA

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ANEMIA, BLOOD LOSS, and TRANSFUSIONS

in NORTH AMERICAN CHILDREN

in the INTENSIVE CARE UNIT

Sri Julyani

Patologi Klinik


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ABSTRACT

Rationale: Minimizing exposure of children toblood products is desirable.

Objectives: We aimed to understand anemia

development, blood loss, and red blood cell(RBC) transfusions in the pediatric intensive

care unit (PICU).

Methods: Prospective, multicenter, 6-monthobservational study in 30 PICUs. Data were

collected onconsecutive children (< 18 yr old)

in the PICU for 48 hours or more.


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After adjusting for age and illness severity,

compared with nontransfused children, children

who underwent transfusion had significantly

longer days of mechanical ventilation (2.1 d, P 48 h inthe PICU


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Exclutioncriteria

Prematur

Priorparticipation

Familyhistory

Relatedresearch

Pregnancy

Braindeath

> 72 h inPICU


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Data collected

Prospectively

Blood loss

Data after

48 h

RetrospectivelyData from the

first 48 h


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Data on addmission

Demographics

Severity of

illness

Daily data

Lowest Hb level

RBC Transfusion

Reason for transfusion

Blood loss

Clinical event

PELOD, MODS

Score :

PRISM III

PELODMODS


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Chi-square : outcomes

predictor

Analysis of varians : anemia

Logistic regressions : complicationfor transfusion, risk for anemiaand transfusion


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5570

986 enrolled9 : case report

incomplete977 : analysis

1.097 :

> 48 h

Result

TABLE 1 BASELINE CHARACTERISTICS OF THE CHILDREN ON


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All Children, n

(%)

Anemia on

Admission, n

(%)

Develop Anemia

>48 h after

Admit, n (%)

Any Transfusion

in PICU, n (%)

Transfusion >48

h after Admit, n

(%)

(n = 977) (n = 322) (n = 176) (n = 475) (n = 162)

Age group


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Admitting category

Cardiovascular system 253 (26) 58 (18) 50 (28) 187 (39) 53 (33)

Nervous system 217 (22) 82 (26) 34 (19) 79 (17) 24 (15)

Digestive system 62 (6) 29 (9) 17 (10) 40 (8) 14 (9)

Endocrine system 17 (2) 3 (1) 4 (2) 6 (1) 4 (3)

Hematologic 39 (4) 27 (8) 1 (1) 31 (7) 9 (6)

Renal/urologic 22 (2) 14 (4) 3 (2) 16 (3) 4 (3)

Respiratory 353 (36) 102 (32) 66 (37) 111 (23) 53 (33)

Comorbid conditions*None 387 (40) 127 (39) 69 (39) 185 (39) 58 (36)

Asthma 112 (12) 37 (11) 17 (10) 36 (8) 13 (8)

Cyanotic congenital heart disease 136 (14) 25 (8) 34 (19) 110 (23) 33 (20)

Nervous system 199 (20) 65 (20) 38 (22) 66 (14) 27 (17)

Renal and urologic 80 (8) 34 (11) 14 (8) 44 (9) 12 (7)

Other 128 (13) 46 (15) 18 (10) 73 (16) 19 (12)

PRISM III score

Mean (SD) 4.2 (5.3) 5.3 (5.8) 3.6 (4.5) 5.6 (5.8) 4.5 (5.1)

Median 2.0 4.0 2.0 4.0 3.0


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Anemia

7 d before : 15 %

Admission : 33%

During : 41%

Never : 26%


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Anemia onadmission>> (5,35,8)

Becameanemia(3,85,1)

Neveranemia(3,34,5)

Severity

ofillness Anemia in

PICU(10,47,8)

Anemia onadmission(8,97,0)

Neveranemia(6,65,9)

Length

of stay


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TABLE 2.PREDICTORS OF DEVELOPMENT OF ANEMIA AFTER PEDIATRIC

INTENSIVE CARE UNIT DAY 2 (n = 438)*

Effect OR (95% Wald confidence limits) PValue

Age category


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No transfusion ICU Days 12 2.6 (1.44.8)


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Blood loss from blooddraws

Prosedur 325(33%)

Spontaneous233 (24%)

Inverse relationship :blood loss/kg and

age

0,25 ml / kg

2,56 ml / kg


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RBC Transfusion

received one or more RBCtransfusions during the PICU stay49%

received a transfusion after PICUdischarge.6 %

22% : between Days 2 and 7

4% : > 7 d after admission to PICU

Firsttransfusion


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Conclusion

Anemia , blood loss, and transfusions in the PICUsignificant.

Efforts to develop guidelines needed

Prospective studies taking into account the dataprovided in this large multicenter epidemiologic study

should be undertaken to estimate the clinical impact of

measures aiming to decrease blood draws, to prevent

or treat anemia, and to decrease transfusions for

critically ill children.


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