Takeaway
- In critically ill children, blood transfusion with fresh vs frozen red blood cells does not affect incidence of onset of progression of multiple organ dysfunction syndrome.
- This randomised trial found no benefit with fresh red blood cell transfusions in these children.
Why this matters
- Some current blood management policies call for fresh blood cell units in some paediatric populations, but this result was consistent across subgroups as well.
- Editorial: It is possible that the trial was underpowered, and the children in this cohort had a relatively low illness severity; however, subgroup analysis consistency suggests validity.
Key results
- Median storage time: 5 (interquartile range, 4-6) days, fresh group vs 18 (12-25) days (P<.001).
- New or progressive syndrome onset incidence did not differ between the groups: 20.2% vs 18.2% (P=.33).
- Sepsis prevalence was 25.8% with fresh vs 25.3% in the standard-issue group (not significant).
- Acute respiratory distress syndrome prevalence was 6.6% (fresh) vs 4.8% (not significant).
- ICU mortality was 4.5% vs 3.5% (not significant).
- Subgroup analyses had similar results.
Study design
- 1538 children (768 fresh; 770 standard-issue) ages 3 days to 16 years attending at 50 tertiary care centres were included.
- Primary outcome: multiple organ dysfunction syndrome development or progression at 28 days.
- Funding: NIH; French Ministry of Health; others.
Limitations
- Patients typically did not require large transfusion volumes.
References
References
