Clinical pathology selected abstracts

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Editor: Deborah Sesok-Pizzini, MD, MBA, chief medical officer, Labcorp Diagnostics, Burlington, NC, and adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Prevalence and determinants of anemia at discharge in pediatric ICU patients

October 2023—Several large randomized controlled trials have shown the safety of tolerating hemoglobin levels as low as 7 g/dL in critically ill hemodynamically stable children. These trials have led to recent guidelines advocating for restrictive transfusion therapy, which is significantly changing practices in pediatric critical care. For example, there has been a reduction in the amount of packed red blood cells (pRBCs) transfused in critically ill children, which mitigates the risk of transfusion reactions and adverse events, including transmission of infectious diseases. On the downside, reducing pRBC transfusion in critically ill children has resulted in more patients being anemic at discharge from the pediatric intensive care unit (PICU). Prolonged anemia has been associated with significant outpatient morbidities, such as fatigue, muscle weakness, neurocognitive disorders, and lower quality of life. Yet there are very limited data about anemia in pediatric patients who undergo congenital heart surgery. The authors conducted a large retrospective study in the PICU of a multidisciplinary university-affiliated tertiary-care health center to describe the prevalence and risk factors of anemia at PICU discharge in three groups: medical patients, cardiac surgery patients, and other surgery patients. The study was performed from January 2013 to January 2018. All patients who had a hemoglobin level available at PICU discharge were included in the study. The baseline characteristics and hemoglobin levels were obtained by searching the electronic medical records database. A total of 4,750 patients were admitted to the PICU, and discharge hemoglobin values were available for 4,124 of them. The data showed that 50.9 percent (2,100) of the patients were anemic at discharge. Anemia was defined by age based on World Health Organization recommendations for children older than six months and the Nelson Textbook of Pediatrics (Philadelphia: Springer; 2016) for infants younger than six months. Anemia at discharge was common in the cardiac surgery population—primarily in acyanotic patients (53.3 percent), whereas only 24.6 percent of cyanotic patients met the standard definitions of anemia. In addition, the cardiac surgery patients were transfused more often and at higher hemoglobin levels compared with the medical and noncardiac surgery patients. The authors noted that transfusion thresholds are still a matter of debate in the congenital heart surgery population. Anemia at admission was the strongest predictor of anemia at discharge (odds ratio, 6.51; 95 percent confidence interval, 5.40–7.85). The study found that half the PICU survivors were anemic at discharge. According to the authors, this was the first study to describe the epidemiology of anemia at PICU discharge in a large mixed cohort. The authors concluded that additional studies are needed to understand the impact of anemia in different pediatric PICU populations and determine long-term sequelae and transfusion strategies.

Jutras C, Sauthier M, Tucci M, et al. Prevalence and determinants of anemia at discharge in pediatric intensive care survivors. Transfusion. 2023;63:973–981.

Correspondence: Dr. Genevieve Du Pont-Thibodeau at genevievedpt@gmail.com