Red blood cell concentrate transfusion strategies utilised at a tertiary-level paediatric intensive care unit : a descriptive study on impact and cost

• Published in: SAJCH : the South African journal of child health 2018-12, Vol.12 (4), p.164-169
• Main Authors: Jeena, P.M., Radebe, P.B.S.
• Format: Article
• Language: English
• Subjects: Blood transfusion; Care and treatment; Composition; Economic aspects; Health aspects; Health Care Sciences & Services; Methods; Pediatric anemia; Pediatric intensive care; Red blood cells
• ISSN: 1994-3032; 1999-7671; 1999-7671
• DOI: 10.7196/SAJCH.2018.v12i4.1517

Background. Optimal haemoglobin threshold for red blood cell (RBC) transfusions in critically ill anaemic children in a paediatric intensive care unit (PICU) is uncertain.Objective. To describe outcomes and costs associated with different RBC transfusion strategies in anaemic patients admitted to a tertiary PICU in Durban, South Africa.Methods. Transfusion data gathered over a 1-year period were analysed retrospectively. RBC transfusion strategies were classified as restrictive, ‘modified liberal’ or mixed. The ‘modified liberal’ group was subdivided into haemodynamically stable or unstable clusters. Transfusion-related effects, comorbidities and mortality were described. Costs associated with RBC transfusions in the various strategy groups were analysed.Results. Over the 118 transfusion records analysed, a restrictive strategy was adopted in 27 cases (22.9%) and a modified liberal strategy was used in 68 cases (57.6%). A mixed strategy was followed in 23 (19.5%) cases. Although mortality was higher in the modified liberal group than in the restrictive group (27.9% v. 11.1%), the difference was not statistically different (p=0.09). There were no differences in the duration of intermittent positive pressure ventilation, length of PICU stay or post-transfusion effects between the restrictive and modified liberal transfusion strategies. A saving of R155 280.15 could have been realised if a restrictive transfusion strategy had been used for haemodynamically stable patients assigned to the modified liberal group. A further R28 988.67 was spent on avoidable after-hours transfusions levies.Conclusion. Adopting a restrictive daytime strategy for RBC transfusions at a PICU could introduce considerable cost savings without affecting outcomes.