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Red blood cell transfusion in infants and children: Indications

Jun Teruya, MD, DSc
Section Editor
Donald H Mahoney, Jr, MD
Deputy Editor
Carrie Armsby, MD, MPH


Transfusion of red blood cells (RBCs) can be life-saving in patients with severe blood loss or patients with severe chronic anemia. On the other hand, RBC transfusion has significant risks, including volume overload, transmission of infectious agents, transfusion reactions, and various immunologic consequences including graft-versus-host disease.

The indications for RBC transfusion in infants and children will be reviewed. Other aspects of transfusion in infants and children are discussed in separate topic reviews:

(See "Red blood cell transfusion in infants and children: Selection of blood products".)

(See "Red blood cell transfusion in infants and children: Administration and complications".)

(See "Red blood cell transfusions in the newborn".)

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Literature review current through: Nov 2017. | This topic last updated: Oct 04, 2016.
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  1. Slonim AD, Joseph JG, Turenne WM, et al. Blood transfusions in children: a multi-institutional analysis of practices and complications. Transfusion 2008; 48:73.
  2. CASE RB, BERGLUND E, SARNOFF SJ. Ventricular function. VII. Changes in coronary resistance and ventricular function resulting from acutely induced anemia and the effect thereon of coronary stenosis. Am J Med 1955; 18:397.
  3. Homi J, Reynolds J, Skinner A, et al. General anaesthesia in sickle-cell disease. Br Med J 1979; 1:1599.
  4. Sloan SR, Benjamin RF, Friedman DF, et al. Transfusion medicine. In: Nathan and Oski's Hematology of Infancy and Childhood, 6th, Nathan DG, Orkin SH, Ginsberg D, Look AT (Eds), WB Saunders, Philadelphia 2003. p.1709.
  5. Spence RK, Swisher SN. Red cell transfusion-the transfusion trigger. In: Clinical practice of transfusion medicine, 3rd, Petz LD, Swisher SN, Kleinman S, et al (Eds), Churchill Livingstone, New York 1996. p.177.
  6. Roseff SD, Luban NL, Manno CS. Guidelines for assessing appropriateness of pediatric transfusion. Transfusion 2002; 42:1398.
  7. Gibson BE, Todd A, Roberts I, et al. Transfusion guidelines for neonates and older children. Br J Haematol 2004; 124:433.
  8. Padhi S, Kemmis-Betty S, Rajesh S, et al. Blood transfusion: summary of NICE guidance. BMJ 2015; 351:h5832.
  9. Agarwal AK, Hastings CA, and Feusner J. Hematologic supportive care for children with cancer. In: Principles and Practice of Pediatric Oncology, 6, Pizzo PA, Poplack DG (Eds), Lippincott Williams and Wilkins, Philadelphia 2011. p.1152.
  10. Lacroix J, Demaret P, Tucci M. Red blood cell transfusion: decision making in pediatric intensive care units. Semin Perinatol 2012; 36:225.
  11. Lacroix J, Hébert PC, Hutchison JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 2007; 356:1609.
  12. American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology 2015; 122:241.
  13. Stylianos S. Liver injury and damage control. Semin Pediatr Surg 2001; 10:23.
  14. Mazine A, Rached-D'Astous S, Ducruet T, et al. Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study. Ann Thorac Surg 2015; 100:671.
  15. Wilkinson KL, Brunskill SJ, Doree C, et al. Red cell transfusion management for patients undergoing cardiac surgery for congenital heart disease. Cochrane Database Syst Rev 2014; :CD009752.
  16. Willems A, Harrington K, Lacroix J, et al. Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis. Crit Care Med 2010; 38:649.
  17. Cholette JM, Rubenstein JS, Alfieris GM, et al. Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection: results of a prospective, randomized, controlled trial of a restrictive versus liberal red-cell transfusion strategy. Pediatr Crit Care Med 2011; 12:39.
  18. Cholette JM, Swartz MF, Rubenstein J, et al. Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion Strategy in Infants Requiring Cardiac Operation. Ann Thorac Surg 2017; 103:206.
  19. Davies MJ, Allen A, Kort H, et al. Prospective, randomized, double-blind study of high-dose aprotinin in pediatric cardiac operations. Ann Thorac Surg 1997; 63:497.
  20. Carrel TP, Schwanda M, Vogt PR, Turina MI. Aprotinin in pediatric cardiac operations: a benefit in complex malformations and with high-dose regimen only. Ann Thorac Surg 1998; 66:153.
  21. Miller BE, Tosone SR, Tam VK, et al. Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations. Ann Thorac Surg 1998; 66:535.
  22. Biswas AK, Lewis L, Sommerauer JF. Aprotinin in the management of life-threatening bleeding during extracorporeal life support. Perfusion 2000; 15:211.
  23. Oliver WC Jr, Santrach PJ, Danielson GK, et al. Desmopressin does not reduce bleeding and transfusion requirements in congenital heart operations. Ann Thorac Surg 2000; 70:1923.
  24. Seear MD, Wadsworth LD, Rogers PC, et al. The effect of desmopressin acetate (DDAVP) on postoperative blood loss after cardiac operations in children. J Thorac Cardiovasc Surg 1989; 98:217.
  25. Reynolds LM, Nicolson SC, Jobes DR, et al. Desmopressin does not decrease bleeding after cardiac operation in young children. J Thorac Cardiovasc Surg 1993; 106:954.
  26. Arnold DM, Fergusson DA, Chan AK, et al. Avoiding transfusions in children undergoing cardiac surgery: a meta-analysis of randomized trials of aprotinin. Anesth Analg 2006; 102:731.
  27. Copley LA, Richards BS, Safavi FZ, Newton PO. Hemodilution as a method to reduce transfusion requirements in adolescent spine fusion surgery. Spine (Phila Pa 1976) 1999; 24:219.
  28. Anand N, Idio FG Jr, Remer S, Hoppenfeld S. The effects of perioperative blood salvage and autologous blood donation on transfusion requirements in scoliosis surgery. J Spinal Disord 1998; 11:532.
  29. Franchini M, Gandini G, Regis D, et al. Recombinant human erythropoietin facilitates autologous blood collections in children undergoing corrective spinal surgery. Transfusion 2004; 44:1122.
  30. Florentino-Pineda I, Blakemore LC, Thompson GH, et al. The Effect of epsilon-aminocaproic acid on perioperative blood loss in patients with idiopathic scoliosis undergoing posterior spinal fusion: a preliminary prospective study. Spine (Phila Pa 1976) 2001; 26:1147.
  31. Neilipovitz DT, Murto K, Hall L, et al. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 2001; 93:82.
  32. Sachs B, Delacy D, Green J, et al. Recombinant activated factor VII in spinal surgery: a multicenter, randomized, double-blind, placebo-controlled, dose-escalation trial. Spine (Phila Pa 1976) 2007; 32:2285.
  33. Faberowski LW, Black S, Mickle JP. Blood loss and transfusion practice in the perioperative management of craniosynostosis repair. J Neurosurg Anesthesiol 1999; 11:167.
  34. Fearon JA, Weinthal J. The use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children. Plast Reconstr Surg 2002; 109:2190.
  35. Dahmani S, Orliaguet GA, Meyer PG, et al. Perioperative blood salvage during surgical correction of craniosynostosis in infants. Br J Anaesth 2000; 85:550.
  36. Hans P, Collin V, Bonhomme V, et al. Evaluation of acute normovolemic hemodilution for surgical repair of craniosynostosis. J Neurosurg Anesthesiol 2000; 12:33.
  37. Williams GD, Bratton SL, Ramamoorthy C. Factors associated with blood loss and blood product transfusions: a multivariate analysis in children after open-heart surgery. Anesth Analg 1999; 89:57.
  38. Kwiatkowski JL, Manno CS. Blood transfusion support in pediatric cardiovascular surgery. Transfus Sci 1999; 21:63.
  39. Erstad BL. Systemic hemostatic medications for reducing surgical blood loss. Ann Pharmacother 2001; 35:925.
  40. Singer ST, Styles L, Bojanowski J, et al. Changing outcome of homozygous alpha-thalassemia: cautious optimism. J Pediatr Hematol Oncol 2000; 22:539.