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

Abstract

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.