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Prevalence of preoperative anemia in pediatric surgical patients and its impact on perioperative blood transfusion

Ioannis A Ioannou1  
,  
Richard Newton2
,  
Ben Clevenger3
,  
David A H de Beer4

1 Consultant, Department of Anaesthesia Great Ormond Street Hospital for Children NHS Foundation Trust London United Kingdom

2 Consultant, Department of Anaesthesia Royal Alexandra Children’s Hospital, Brighton United Kingdom

3 Consultant, Department of Anaesthesia Royal National Orthopaedic Hospital NHS Trust London United Kingdom

4 Consultant, Department of Anaesthesia Great Ormond Street Hospital for Children NHS Foundation Trust London United Kingdom

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Ioannis A Ioannou

Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH,

United Kingdom

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Article ID: 100019A05II2019

doi: 10.5348/100019A05II2019RA

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How to cite this article

Ioannou IA, Newton R, Clevenger B, de Beer DAH. Prevalence of preoperative anemia in pediatric surgical patients and its impact on perioperative blood transfusion. Edorium J Anesth 2019;5:100019A05II2019.

ABSTRACT

Aim: To determine the prevalence of preoperative anemia in children presenting for surgery at our institution and to establish whether preoperative anemia increased the likelihood of perioperative transfusion.
Methods: A retrospective review of all noncardiac surgical patients over a 2-week period. Data were collected for demographics, type of surgery, hemoglobin concentration within 28 days of surgery, severity of anemia and whether a blood transfusion was administered within 28 days of surgery.
Results: 723 patients underwent non-cardiac surgery during the study period, of which 334 had a preoperative hemoglobin measurement, 116 of those were anemic. Blood transfusion was administered in 19.9% of all anemic patients, compared to 5.4% of non-anemic patients (odd ratio [OR] 4.383; 95% confidence interval [CI], 2.10–9.53; p <0.0001). In anemic children over six months of age, 75.3% were of moderate severity, 22.6% were mild, and 2.1% severe, with transfusion rates being similar 23.6, 15.1, and 33.0%, respectively. The prevalence of anemia increased with ASA severity with blood transfusion occurring more often in anemic than non-anemic patients in all ASA grades. Anemic patients who underwent intermediate or major procedures were significantly more likely to be transfused than their non-anemic counterparts, with no significant difference seen for minor procedures.
Conclusion: Preoperative anemia is common in children presenting for surgery at our institution and in the majority of cases, this is of moderate severity. Preoperative anemia is associated with an increased likelihood of perioperative blood transfusion compared to patients with hemoglobin concentrations within the normal range.

Keywords: Hemoglobin optimization, Patient blood management, Preoperative anemia, Perioperative transfusion

SUPPORTING INFORMATION

Author Contributions

Ioannis A Ioannou - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Richard Newton - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published

Ben Clevenger - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

David A H de Beer - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published

Guaranter of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2019 Ioannis A Ioannou et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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