P1.012: Current Practices in PRBC Transfusion in the Pediatric Intensive Care Unit: A Retrospective Review

Background: Packed red blood cell (PRBC) transfusions are a frequent practice in the pediatric intensive care unit (PICU), primarily used to treat anemia and ensure adequate oxygen delivery to tissues in critically ill children. However, there is significant variability in transfusion practices, including the hemoglobin or hematocrit thresholds used to determine when to transfuse. Given the broad inconsistencies in transfusion practices reported in the literature, we aimed to describe our experience in a tertiary-level PICU. Our aim was to evaluate what are the hemoglobin and hematocrit thresholds for PRBC transfusion in a pediatric critical care unit, and how do they impact patient outcomes? And what is the timing for PRBC transfusion during the PICU admission? We hypothesize that the practices on the use of PRBC in the PICU in a tertiary pediatric hospital in Puerto Rico have a restrictive approach and that the majority of our patients get transfused in the first 72 hours of admission.

Methods: We conducted a retrospective cohort study by reviewing the medical records of patients who received PRBCs during their PICU stay during a six-month period (July 2024 to December 2024). The following data was collected from electronic medical charts: red blood cell transfusion events, patient’s demographics for each event, admission diagnosis, admission management variables, PICU length of stay, time to transfusion, transfusions adverse reactions, hemoglobin and hematocrit levels, use of vasoactive agents, use of invasive mechanical ventilation and mortality rate from those who received PRBCs during study period. Statistical analysis was done using Graphpad prism and Julius AI.

Results: From a total of 394 admissions in a 6-month period, 45 patients received PRBC transfusions. Events and patients were analyzed separately. We found that our median hemoglobin level for transfusion was 6.9 g/dL and hematocrit level was 22%, trending towards a conservative transfusion strategy. Our median volume of transfusion is 244 ml per transfusion and the average weight of patients was 14.2 kilograms. Surprisingly we encountered that the median time to transfusion is 6 days. Most of our patients were males and the median length of stay of our overall study population was 17 days, and the median length of stay of patient’s who died during the study was 7 days. There was a mortality of 7% in the patients who were transfused compared to the overall PICU mortality of 3.3% during the study period.

Conclusion: Due to the limited data on transfusion practices in pediatric patients in the PICU in Puerto Rico, this research aimed to describe our current practices. We evaluated our adherence to established guidelines and identified our approach to ensuring that PRBC transfusions are administered safely and effectively to critically ill children.