• Pierre Demaret, Oliver Karam, Julien Labreuche Bst, Fabrizio Chiusolo, Mayordomo Colunga Juan J Sección de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain. , Simon Erickson, Marianne E Nellis, Marie-Hélène Perez, Samiran Ray, Marisa Tucci, Ariane Willems, Alain Duhamel, Frédéric Lebrun, Isabelle Loeckx, André Mulder, Stéphane Leteurtre, and Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP); the Pediatric Critical Care Blood Research Network (BloodNet); and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.
• Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium.
• Pediatr Crit Care Me. 2020 Jun 1; 21 (6): e342-e353.

ObjectiveTo describe the management of anemia at PICU discharge by pediatric intensivists.DesignSelf-administered, online, scenario-based survey.SettingPICUs in Australia/New Zealand, Europe, and North America.SubjectsPediatric intensivists.InterventionsNone.Measurements And Main ResultsRespondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered separately in order to assess their effect on the management of anemia. Two-hundred seventeen responses were analyzed. They reported that the mean (± SEM) transfusion threshold was a hemoglobin level of 6.9 ± 0.09 g/dL after hemorrhagic shock, 7.6 ± 0.10 g/dL after cardiac surgery, 7.0 ± 0.10 g/dL after craniofacial surgery, and 7.0 ± 0.10 g/dL after polytrauma (p < 0.001). The most important increase in transfusion threshold was observed in the presence of a cyanotic heart disease (mean increase ranging from 1.80 to 2.30 g/dL when compared with baseline scenario) or left ventricular dysfunction (mean increase, 1.41-2.15 g/dL). One third of respondents stated that they would not prescribe iron at PICU discharge, regardless of the hemoglobin level or the baseline scenario. Most respondents (69.4-75.0%, depending on the scenario) did not prescribe erythropoietin.ConclusionsPediatric intensivists state that they use restrictive transfusion strategies at PICU discharge similar to those they use during the acute phase of critical illness. Supplemental iron is less frequently prescribed than RBCs, and prescription of erythropoietin is uncommon. Optimal management of post-PICU anemia is currently unknown. Further studies are required to highlight the consequences of this anemia and to determine appropriate management.

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