P2A226: Adherence to Transfusion Thresholds in Two United States Pediatric Intensive Care Units

Background: A national hemoglobin transfusion threshold of 7 g/dL and platelet count threshold of 20 K/UL are indicators for RBC and platelet transfusions. However, clinicians may transfuse without following thresholds. Therefore, we hypothesize that adherence rates to national transfusion guidelines will vary between two pediatric ICUs (PICUs) of the same health system.

Methods: Retrospective chart review of 212 RBC (106 FL and DE) and 112 platelet (56 FL and DE) non-prophylactic transfusions among patients < 18 years old admitted in 2017-2020 at Nemours Children’s Health FL and DE was performed. EMR data (demographics, interventions, and outcomes) were collected into a REDCap survey. Chi-square testing evaluated adherence to transfusion thresholds between institutions.

Results: There were no significant differences between institutional threshold adherence for RBCs (50% FL vs. 55% DE, p=0.492) or platelets (46.4% FL vs. 28.6% DE, p=0.051). Comparing adherent vs. non-adherent RBC transfusions revealed significant differences in mean length of stay (19 vs. 30 days, p=0.021) and mean pre-transfusion hemoglobin (5.9 vs. 8.5 g/dL, p= < 0.001). In FL and DE, adherent transfusions revealed significant differences in mean change in hemoglobin compared to non-adherent transfusions (FL adherent vs. non adherent: 3.2 vs. 2.2 g/dL, p=0.002; DE adherent vs. non adherent: 2.7 vs. 1.6 g/dL, p=0.002). Comparing adherent vs. non-adherent platelet transfusions revealed significant differences in mean length of stay (20 days vs. 35 days, p= < 0.001) and mean pre-transfusion platelet count (12.6 vs. 52.1 K/UL, p= < 0.001). In DE, adherent transfusions revealed a significant difference in mean change in platelet count compared to non-adherent transfusions (37.0 vs. 20.2 K/UL, p=0.02).

Conclusion: Adherence rates to transfusion guidelines did not vary between the two PICUs, although transfusion guidelines were not well adhered to. Moreover, when clinicians were adherent to thresholds, mean hemoglobin and platelet counts were well below thresholds. Both institutions' RBC adherent groups and the DE platelet adherent group exhibited greater mean change in hemoglobin values or platelet counts. Patients experienced shorter hospital stays when clinicians adhered to national transfusion guidelines.