Pediatric Cardiology

, Volume 36, Issue 6, pp 1212–1218 | Cite as

Association of Hematocrit and Red Blood Cell Transfusion with Outcomes in Infants Undergoing Norwood Operation

  • Punkaj GuptaEmail author
  • Caitlin King
  • Lisle Benjamin
  • Timothy Goodhart
  • Michael J. Robertson
  • Jeffrey M. Gossett
  • Gina A. Pesek
  • Rahul DasGupta
Original Article


The objective of this study was to investigate the association between red blood cell (RBC) transfusion and hematocrit values with outcomes in infants undergoing Norwood operation. This study included infants ≤2 months of age who underwent Norwood operation with either a modified Blalock–Taussig shunt or a right ventricle-pulmonary artery shunt. Demographics, preoperative, operative, daily laboratory data, and postoperative variables were collected. The primary outcome measures evaluated included mortality, ICU length of stay, length of mechanical ventilation, and days to chest closure. The secondary outcome measures evaluated included lactate levels, estimated glomerular filtration rate, and inotrope score in the first 14 days after heart operation. Cox proportional hazard models were fitted to study the probability of study outcomes as a function of hematocrit values and RBC transfusions after operation. Eighty-nine patients qualified for inclusion. With a median hematocrit of 46 (IQR 44, 49), and a median RBC transfusion of 92 ml/kg (IQR 31, 384) in the first 14 days after operation, 81 (91 %) patients received RBC transfusions. A multivariable analysis adjusted for risk factors, including the age, weight, prematurity, cardiopulmonary bypass and cross-clamp time, and postoperative need for nitric oxide and dialysis, demonstrated no association between hematocrit and RBC transfusion with majority of study outcomes. This single-center study found that higher hematocrit values and increasing RBC transfusions are not associated with improved outcomes in infants undergoing Norwood operation.


Hematocrit Infants Congenital heart disease Norwood Blood transfusion 


Conflict of interest



  1. 1.
    Armano R, Gauvin F, Ducruet T, Lacroix J (2005) Determinants of red blood cell transfusions in a pediatric critical care unit: a prospective, descriptive epidemiological study. Crit Care Med 33:2637–2644PubMedCrossRefGoogle Scholar
  2. 2.
    Bateman ST, Lacroix J, Boven K, Forbes P, Barton R, Thomas NJ, Jacobs B, Markovitz B, Goldstein B, Hanson JH, Li HA, Randolph AG (2008) Anemia, blood loss and blood transfusion in North American children in the intensive care unit. Am J Respir Crit Care Med 178:26–33PubMedCrossRefGoogle Scholar
  3. 3.
    Bennett-Guerrero E, Veldman TH, Doctor A, Telen MJ, Ortel TL, Reid TS, Mulherin MA, Zhu H, Buck RD, Califf RM, McMahon TJ (2007) Evolution of adverse changes in stored RBCS. Proc Natl Acad Sci 104:17063–17068PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Blackwood J, Joffe AR, Robertson CM, Dinu IA, Alton G, Penner K, Ross DB, Rebeyka IM (2010) Association of hemoglobin and transfusion with outcome after operations for hypoplastic left heart. Ann Thorac Surg 89(5):1378-84.e1–1378-84.e2CrossRefGoogle Scholar
  5. 5.
    Chin-Yee I, Arya N, d’Almeida MS (1997) The red cell storage lesion and its implications for transfusion. Transfus Sci 18:447–458PubMedCrossRefGoogle Scholar
  6. 6.
    Cholette JM, Rubenstein JS, Alfieris GM, Powers KS, Eaton M, Lerner NB (2011) Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection: results of a prospective, randomized, controlled trial of a restrictive versus liberal red-cell transfusion strategy. Pediatr Crit Care Med 12(1):39–45PubMedCrossRefGoogle Scholar
  7. 7.
    Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ (2004) The CRIT study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 32:39–52PubMedCrossRefGoogle Scholar
  8. 8.
    de Gast-Bakker DH, de Wilde RB, Hazekamp MG, Sojak V, Zwaginga JJ, Wolterbeek R, de Jonge E, Gesink-van der Veer BJ (2013) Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial. Intensive Care Med 39(11):2011–2019PubMedCrossRefGoogle Scholar
  9. 9.
    Guzzetta NA (2010) Benefits and risks of red blood cell transfusion in pediatric patients undergoing cardiac surgery. Pediatr Anesth 21:504–511CrossRefGoogle Scholar
  10. 10.
    Hebert PC, Tinmouth A, Corwin HL (2007) Controversies in RBC transfusion in the critically ill. Chest 131:1583–1590PubMedCrossRefGoogle Scholar
  11. 11.
    Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409–417PubMedCrossRefGoogle Scholar
  12. 12.
    Howard-Quijano K, Schwarzenberger JC, Scovotti JC, Alejos A, Ngo J, Gornbein J, Mahajan A (2013) Increased red blood cell transfusions are associated with worsening outcomes in pediatric heart transplant patients. Anesth Analg 116(6):1295–1308PubMedCrossRefGoogle Scholar
  13. 13.
    Kneyber MC, Hersi MI, Twisk JW, Markhorst DG, Plotz FB (2007) Red blood cell transfusion in critically ill children is independently associated with increased mortality. Intensive Care Med 33:1414–1422PubMedCrossRefGoogle Scholar
  14. 14.
    Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS (2002) Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg 73(2):538–545PubMedCrossRefGoogle Scholar
  15. 15.
    Kwiatkowski JL, Manno CS (1999) Blood transfusion support in pediatric cardiovascular surgery. Transfus Sci 21:63–72PubMedCrossRefGoogle Scholar
  16. 16.
    Lacroix J, Hébert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, Gauvin F, Collet JP, Toledano BJ, Robillard P, Joffe A, Biarent D, Meert K, Peters MJ (2007) Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 356:1609–1619PubMedCrossRefGoogle Scholar
  17. 17.
    Lavoie J (2011) Blood Transfusion risks and alternative strategies in pediatric patients. Pediatr Anesth 21:14–24CrossRefGoogle Scholar
  18. 18.
    Marik PE, Corwin HL (2008) Efficacy of red blood transfusion in the critically ill: a systematic review of the literature. Crit Care Med 36:2667–2674PubMedCrossRefGoogle Scholar
  19. 19.
    Reynolds JD, Ahearn GS, Angelo M, Zhang J, Cobb F, Stamler JS (2007) S nitrosohemoglobin deficiency: a mechanism for loss of physiological activity in banked blood. Proc Natl Acad Sci 104:17058–17062PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20(3):629–637PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Szekely A, Cserep Z, Sapi E, Breuer T, Nagy CA, Vargha P, Hartyanszky I, Szatmari A, Treszel A (2009) Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations. Ann Thorac Surg 87:187–197PubMedCrossRefGoogle Scholar
  22. 22.
    Tinmouth A, Chin-Yee I (2001) The clinical consequences of the red cell storage lesion. Transfus Med Rev 15:91–107PubMedCrossRefGoogle Scholar
  23. 23.
    Willems A, Harrington K, Lacroix J, Biarent D, Joffe AR, Wensley D, Ducruet T, Hébert PC, Tucci M (2010) Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis. Crit Care Med 38:649–656PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Punkaj Gupta
    • 1
    • 2
    • 7
    Email author
  • Caitlin King
    • 3
  • Lisle Benjamin
    • 3
  • Timothy Goodhart
    • 3
  • Michael J. Robertson
    • 3
  • Jeffrey M. Gossett
    • 4
  • Gina A. Pesek
    • 5
  • Rahul DasGupta
    • 6
  1. 1.Division of Pediatric CardiologyUniversity of Arkansas Medical SciencesLittle RockUSA
  2. 2.Division of Critical CareUniversity of Arkansas Medical SciencesLittle RockUSA
  3. 3.Department of Medical Education, College of MedicineUniversity of Arkansas Medical SciencesLittle RockUSA
  4. 4.Division of Biostatistics, Department of PediatricsUniversity of Arkansas Medical SciencesLittle RockUSA
  5. 5.Department of Transfusion MedicineUniversity of Arkansas Medical SciencesLittle RockUSA
  6. 6.Division of Pediatric Anesthesia, Department of AnesthesiologyUniversity of Arkansas Medical SciencesLittle RockUSA
  7. 7.College of Medicine, Sections of Pediatric Cardiology and Critical Care Medicine, Arkansas Children’s HospitalUniversity of Arkansas for Medical SciencesLittle RockUSA

Personalised recommendations