REVIEWCurrent hemoglobin thresholds in pediatric anesthesia - guidelines and studiesWittenmeier, Eva; Komorek, Yannick; Engelhard, Kristin Author Information Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany Correspondence to Eva Wittenmeier, Universitätsmedizin Mainz: Johannes Gutenberg Universitat Mainz, Mainz, Germany. Tel: +49 6131 17 6751; e-mail: [email protected] Current Opinion in Anaesthesiology ():10.1097/ACO.0000000000001253, February 16, 2023. | DOI: 10.1097/ACO.0000000000001253 Buy PAP Metrics Abstract Purpose of review The use of restrictive transfusion triggers to avoid unnecessary transfusions is one important pillar of Patient Blood Management (PBM). For the safe application of this principle in pediatric patients, anesthesiologists need evidence-based guidelines for hemoglobin (Hb) transfusions thresholds in this specially vulnerable age-group. Recent findings This review outlines recent prospective and observational studies examining transfusion thresholds in pediatrics. Recommendations to use transfusion triggers in the perioperative or intensive care setting are summarized. Summary Two high-quality studies confirmed that the use of restrictive transfusion triggers in preterm infants in the intensive care unit (ICU) is reasonable and feasible. Unfortunately, no recent prospective study could be found investigating intraoperative transfusion triggers. Some observational studies showed wide variability in Hb levels before transfusion, a tendency toward restrictive transfusion practices in preterm infants, and liberal transfusion practices in older infants. Although there are comprehensive and useful guidelines for clinical practice in pediatric transfusion, most of them do not cover the intraoperative period in particular because of a lack of high-quality studies. This lack of prospective randomized trials focusing on intraoperative transfusion management remains a major problem for the application of pediatric PBM. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
