Anemia in Pediatric Critical Care

Abstract

Anemia is a common complication of pediatric critical illness; close to 75% of children that are admitted to the pediatric intensive care unit (PICU) are anemic at some point during their stay. The causes of anemia of critical illness are multifactorial and are most often attributable to inflammation and/or blood losses (iatrogenic or disease-related). The impact of anemia in critically ill children is unclear but given that hemoglobin is an important factor in the body’s oxygen-carrying capacity, low hemoglobin can result in insufficient oxygen delivery to vital organs and tissues especially in the context of an acute illness. The management of anemia of critical illness is yet to be developed. Transfusions of red blood cells are the fastest way to increase hemoglobin; however, they are associated with adverse events. Current recommendations suggest limiting transfusions to hemoglobin levels below 7g/dL in hemodynamically stabilized children. Iron and erythropoietin have been investigated to manage and/or prevent anemia; yet studies on these two therapeutic options have been either negative or inconclusive. Another approach to reduce or prevent anemia is to reduce blood testing and iatrogenic blood losses. Multiples strategies have shown promising results, such as small-volume phlebotomy, in-line blood testing and modifying physician behavior with regard to blood testing orders. Further studies are required to determine how efficient these interventions are to reduce the prevalence of anemia at PICU discharge. Anemia is a significant complication of critical illness and 50% of children are discharged from the PICU anemic. The long-term impact of this complication on these children is unknown, in particular the impact on their long-term neurocognitive development. Structured follow-up is required to understand the trajectory and consequences of anemia in this particular population.

Keywords:

• anemia
• pediatric
• critical care
• management

Disclosure

The authors report no conflicts of interest for this work.