An Individualized Red Blood Cell Transfusion Strategy Using Pediatric Perioperative-Transfusion-Trigger Score Reduced Perioperative Blood Exposure for Children: A Randomized Controlled Clinical Trial

Abstract

Background The optimal red blood cell transfusion strategy in children remains unclear. We developed an individualized pediatric red blood cell transfusion strategy, and postulated that red blood cell transfusion guided by this strategy in children would reduce blood exposure without compromising patients’ safety. Methods In this randomized controlled clinical trial, 99 children undergoing non-cardiac surgeries who had blood loss of more than 20% total blood volume were randomly assigned to an individualized-strategy group using Pediatric Perioperative-Transfusion-Trigger Score, or a control group. The amount of transfused red blood cells was counted, and patients were followed up for postoperative complications by day-30. This trial was registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR-IRP-16007909, Date:07/02/2016). Results 26 children (53.1%) in individualized-strategy group received transfusion perioperatively, as compared with 37 children (74%) in the control group (p<0.05). During surgery, children in individualized-strategy group were exposed to fewer transfusions than in the control group (0.87±1.03 vs. 1.33±1.20 red-blood-cell units per patient, p<0.05). The incidence of severe complications in individualized-strategy group had the lower trend compare to the control group (8.2% vs. 18%, p=0.160). No significant differences were found in the other outcomes. Conclusion This study proved that transfusion guided by the individualized strategy reduced perioperative blood exposure in children, without increasing the incidence of severe complications. This conclusion needs to be further confirmed by implementing multicenter, large-sample clinical trials. Trial registration The study was registered at http://www.chictr.org.cn/showprojen.aspx?proj=13361 (Registration number: ChiCTR-IRP-16007909, Date:07/02/2016).