Restrictive Transfusion Policies: 2018 Pediatric Surgery Practice Gap #10
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Key Takeaways
- Transfusing to hemoglobin of 7 g/dL vs 9-10 g/dL shows no difference in mortality across pediatric surgical patients including NICU
- Blood transfusions increase DVT risk in pediatric patients; use restrictive transfusion strategies when clinically appropriate
- Many institutions mandate hemoglobin ≥10 g/dL for NICU patients going to OR, but evidence supports lower threshold of 7 g/dL
- Transfuse based on clinical status rather than arbitrary hemoglobin targets; patients tolerate lower hemoglobin when stable
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Hey guys, so in about two months, the 2019 annual update course is coming again. This will be the seventh one. And I know that last year we had APSA come and APSA's PDC, uh the Practice Development Committee, who helped identify practice gaps for us. Alex, what were these practice gaps? Yeah, so essentially the PDC uh, they identified uh areas that pediatric surgeons don't know about. And the thing is that not only do we not know about them, we don't know that we don't know about them. Yep and a practice gap is the distance between what is best practices or evidence based and what you should be doing and what actually happens. So not only do I not know what I don't know, I don't know when I don't know it. This is just kind of their effort to help identify areas that we could improve on and help spread the message that kind of take away key points for those gaps. So, I think it was last year was David Powell, Craig Lillehei, and Chuck Snyder, and they presented some major practice gaps. Number 10 was restrictive transfusion policies and they shared that transfusing to a target hemoglobin of seven instead of nine or 10 like some institutions do, actually has no difference in mortality. And in addition to this, they wanted us to remember that blood transfusions increase the risk risk of DVT in patients, so we should be careful with them. that according to the PDC and uh that the restrictive transfusion policy of seven, not nine or 10, uh is probably going to have no it will have no difference in mortality. So Alex, just to clarify, this is not just trauma, this is across the board pediatric patients. Correct. Uh they made some examples with NICU patients and other general surgery patients as well. Right because at a lot of hospitals when you want to take a NICU baby to the operating room, they mandate that the patient has a hemoglobin of 10. And now we're saying you don't need 10. Yeah, transfuse clinically. If patient's doing well, they can sit there with lower hemoglobin levels.