Çocuk Yoğun Bakım Ünitesi Hastalarına Uygulanan Transfüzyonlarının İncelenmesi
Özet
Hacettepe University Faculty of Medicine, Department of Pediatrics, Specialist Thesis, Ankara, 2023. Red blood cell (RBC) transfusion is a commonly used treatment method in pediatric intensive care units (PICU). Studies have shown that 15-50% of patients admitted to the PICU undergo RBC transfusion. RBC transfusion can be a lifesaving treatment but can also cause serious complications and increase mortality rates. Many studies have been conducted to improve transfusion strategies. This thesis aims to investigate the transfusion experiences of patients admitted to the PICU and potential risks and solutions for its improvement.
The study included 2011 patients aged 28 days to 18 years admitted to the Ihsan Doğramacı Children's Hospital Pediatric Intensive Care Unit between December 31, 2015, and January 1, 2021. The patients' demographic characteristics, presenting complaints, RBC transfusion information, pre- and post-transfusion laboratory tests, temporal characteristics, risk assessment scores, and clinical outcomes were retrospectively examined. Relationships between features and survival analyses were conducted in the study.
During the study period, 27% of the patients (n=558) received at least one RBC transfusion. Statistically significant categorical features found to pose a risk for RBC transfusion included age category, admission diagnoses, malnutrition categories, presence of anemia at admission, mechanical ventilation, and central venous catheter (CVC) placement. Statistically significant numeric variables included patient admission blood hemoglobin levels, risk scores, blood RDW levels, age, and age-related weight Z scores. In the survival analysis, presenting complaints, age categories, admission location, malnutrition status, anemia status, mechanical ventilation application, and CVC placement were found to be statistically significant.
This article emphasizes the importance of using RBC transfusion appropriately in clinical practice and warns that unnecessary transfusion may bring many risks. According to studies on this subject, various factors, including patients' age, sex, disease status, hemoglobin levels, PRISM-III score, presence or absence of anemia at admission, hemodynamic status, and malnutrition status, should be considered. Objective clinical assessment is required to determine the necessity of RBC transfusion correctly.
Moreover, to avoid side effects resulting from unnecessary RBC transfusion, strategies to reduce blood loss should be adopted. These strategies include using smaller volume sample tubes, point-of-care tests, closed system blood sampling, non-invasive testing devices, blood sampling by experienced teams, developing protocols to prevent inappropriate repetition of laboratory tests used for monitoring and follow-up, and timely removal of unnecessary catheters.
In conclusion, this article highlights the factors and importance of correctly determining and applying RBC transfusion. Incorrectly determined RBC transfusion may bring many risk factors when applied unnecessarily. Therefore, objective clinical assessment and adopting strategies to reduce blood loss are crucial for correctly determining and avoiding unnecessary RBC transfusion.
