The Effect of Diagnostic Blood Loss on Anemia and Transfusion Among Postoperative Patients With Congenital Heart Disease in a Pediatric Intensive Care Unit

Purpose To evaluate whether diagnostic blood loss can lead to anemia and consequent blood transfusion among postoperative patients with congenital heart disease (CHD) in the pediatric intensive care unit (PICU). Design and Methods This prospective observational study was conducted in a university-affiliated tertiary hospital between January and August 2016. CHD patients aged 48 h were included (n = 205). Multivariate logistic regression analyses were used to determine the effect of diagnostic blood loss on anemia and transfusion. Results The mean daily phlebotomy volume was 5.40 ± 1.94 mL/d during the PICU stay (adjusted for body weight, 0.63 ± 0.36 mL/kg/d). Daily volume/kg was associated with cyanotic CHD, Pediatric Risk of Mortality III score, and Pediatric Logistic Organ Dysfunction (PELOD)-2 score. In total, 101 (49.3%) patients presented with new or more severe anemia after admission to PICU, which was not associated with phlebotomy volume. Forty-one (20.0%) children received one or more RBC transfusions during their PICU stay. Multivariate analysis indicated that PELOD-2 score > 5, new or more severe anemia, and daily volume/kg of phlebotomy > 0.63 mL/kg/d were significantly associated with transfusion after 48 h of admission to PICU. Conclusions Our findings indicate that diagnostic blood loss is not related to postoperative anemia in children with CHD; however, this factor does correlate with blood transfusion, since it somewhat reflects the severity of illness. Practice Implications Strategies should be applied to reduce diagnostic blood loss, as appropriate.