Effects Of Blood Conservation On The Incidence Of Anemia And Transfusions In Pediatric Parapneumonic Effusion: A Hospitalist Perspective

BACKGROUND: Children with pneumonia may develop parapneumonic effusion (PNE). The associated inflammatory process and nutritional compromise can blunt erythropoesis. Traditional treatment for these children with PNE includes repeated phlebotomy and surgical intervention, resulting in ongoing blood losses. Blood transfusions used to treat acquired anemia are associated with multiple complications.OBJECTIVES: This study evaluated the effect of hospitalists' implementation of blood conservation guidelines (BCG) on the incidence of anemia and transfusion requirements in children with PNE.DESIGN: Retrospective cohort study of hospitalized children with PNE.SETTINGS: University affiliated Children's Hospital.PATIENTS: Children who were admitted to the hospital with PNE and managed using BCG (Group I) were compared to simultaneous no intervention group (S) and historical no intervention group (H). Group (I) and (S) were admitted from year 2000 to 2004 and the Group (H) were admitted from year 1997 to 1999.MEASUREMENTS: Phlebotomy frequency and volume, measured hemoglobin (Hgb) levels, and the need for red blood transfusions.RESULTS: Children in the BCG group (n = 24) compared to simultaneous no intervention group (n 28) and historical no intervention group (n = 29) had lesser phlebotomy volumes (14 +/- 8, 18 +/- 14 and 69 +/- 66 mL; P = 0.001), trend toward lesser Hgb drop (1.7 +/- 1.4, 2.1 +/- 1.2 and 2 +/- 1.4 gm%; P <= 0.37), and lesser incidence of transfusion (8%, 18% and 31%; P = 0.11). Transfused children were younger (3.5 +/- vs. 6.4 +/- 4 years; P = 0.001) and had lower initial Hgb (9.9 +/- 1 vs. 11.4 +/- 1 gm%; P = 0.001), more phlebotomy (5.9 +/- 7 vs. 1.1 +/- 1 mL/ kg., P = 0.001), longer hospitalization (18.7 +/- 5 vs. 11.1 +/- days; P = 0.001), and slightly higher (pediatric risk of mortality [PRISM]) scores (3.4 +/- 5.7 vs. 1.6 +/- 2.7; P = 0.25).CONCLUSION: Implementing BCG lowers phlebotomy losses and the need for transfusion. Journal of Hospital Medicine 2010; 5: 410-413. (C) 2010 Society of Hospital Medicine.