KMID : 1155520150100030141
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Anesthesia and Pain Medicine 2015 Volume.10 No. 3 p.141 ~ p.148
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Transfusion guidelines in pediatric patients
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Lee Jong-Wha
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Abstract
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To avoid unnecessary transfusions of blood products, a patient¡¯s current hematologic and hemodynamic status must be evaluated thoroughly by assessing on-going and anticipated bleeding using a pre-determined transfusion threshold, and overall physiological conditions should be monitored using various parameters. A large, randomized investigation of critically ill pediatric patients demonstrated that a restrictive approach, with a lower hemoglobin transfusion threshold of 7.0 g/dl, was not harmful during the immediate postoperative period, compared to a liberal hemoglobin policy of 9.0 g/dl. Subgroup analyses supported a restrictive policy in patients with more serious conditions. Furthermore, packed red blood cell transfusion was related to adverse postoperative outcomes, such as prolonged mechanical ventilation. Therefore, a ¡°restrictive¡± policy can be adopted for intraoperative transfusion in otherwise healthy patients. However, more investigations are needed to replace the conventional ¡°liberal¡± approach in patients with compromised oxygenation, such as cyanotic congenital heart disease or pulmonary insufficiency. There is no ¡°universal¡± transfusion threshold for all pediatric patients.
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KEYWORD
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Blood transfusion, Practice guideline, Pediatric patients
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