Real-world Red Blood Cell Transfusion Practices in Hospitalized Pediatric Patients: A 10-year Retrospective Study

Abstract

Red blood cell (RBC) transfusion is a common intervention in hospitalized pediatric patients; however, real-world data on transfusion practices across heterogeneous clinical settings remain limited. This retrospective single-center study aimed to evaluate pediatric RBC transfusion practices over a 10-year period, with a focus on transfusion thresholds, clinical indications, and practice variability. A total of 120 pediatric patients and 339 RBC transfusion episodes were analyzed. The mean pre-transfusion hemoglobin (Hb) level was 7.24±1.39 g/dL; however, thresholds varied across diagnostic categories, being lowest in iron deficiency anemia and highest in chronic transfusion-dependent, septic, and bleeding patients. The mean post-transfusion Hb was 9.77±2.03 g/dL, with an average Hb increment (ΔHb) of 2.69±1.71 g/dL. Transfusion-related adverse reactions were observed in 3.2% of transfusions; no delayed reactions were documented. Clinical indications were heterogeneous, including iron deficiency anemia, sepsis, malignancy, hemoglobinopathies, and acute bleeding. Most transfusions were administered in inpatient wards (76.1%), while 23.9% occurred in intensive care units. Notably, post-transfusion complete blood count monitoring was not performed in 20.6% of episodes, indicating a gap in routine practice. These findings indicate that pediatric RBC transfusion practices were broadly consistent with restrictive strategies, with higher thresholds largely observed in context-dependent clinical subgroups, and that they were associated with an expected Hb response and a low documented rate of acute transfusion reactions. However, considerable variability in indications and deficiencies in post-transfusion monitoring highlight the need for improved standardization and adherence to evidence-based transfusion practices in pediatric care.