Pediatrics · Hematology ·
Clinical and laboratory factors associated with transfusion in children with severe anemia
A retrospective study of 186 children with severe anemia presenting to a tertiary pediatric emergency department identified clinical signs and laboratory findings associated with red blood cell transfusion. Nearly half received transfusions; the findings support considering more than hemoglobin concentration alone, but do not establish transfusion thresholds or treatment benefit.
- Retrospective review included 186 children with severe anemia.
- Forty-seven percent received red blood cell transfusions.
- Clinical signs and laboratory factors were associated with transfusion.
- Estimated median hemoglobin rise was 1.80 g/dL per 10 mL/kg.
Researchers retrospectively reviewed 186 children aged 1 month to 18 years who met World Health Organization age-specific criteria for severe anemia and presented to a tertiary pediatric emergency department in 2023–2025. They assessed anemia causes and used LASSO and multivariable logistic regression to identify factors associated with red blood cell transfusion; quantile regression estimated hemoglobin increases after transfusion.
Impaired red cell formation was the most common mechanism (70.4%), with nutritional anemia accounting for 53.2%. Eighty-eight children (47.3%) received transfusions. Independent predictors included heart murmur (OR 16.08), hepatomegaly (OR 8.25), splenomegaly (OR 5.33), tachycardia (OR 5.28), normocytosis (OR 8.99), lower hemoglobin (OR 0.26), and elevated red cell distribution width (OR 0.04). The estimated median hemoglobin increment was 1.80 g/dL per 10 mL/kg transfused.
The single-center retrospective findings describe factors associated with clinicians’ transfusion decisions, not evidence that these factors should determine treatment or that a particular threshold is optimal. The authors’ results support assessing clinical signs alongside laboratory values, but require validation in other populations before guiding practice.
In practice
For children with severe anemia presenting to emergency care, this single-center retrospective study found that transfusion was associated with hemoglobin level, blood indices, and signs including tachycardia, murmur, hepatomegaly, and splenomegaly. These findings highlight factors clinicians considered alongside hemoglobin in this cohort, but they do not establish a transfusion rule or demonstrate improved outcomes from using these predictors. The results need validation in other settings and should not by themselves change transfusion thresholds.
AI-generated clinical interpretation · Not editor-reviewed
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Pediatric Research: Beyond hemoglobin thresholds: identifying clinical predictors for red blood cell transfusion in pediatric severe anemia ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.