Abstract 2253: What is the Ideal Hemoglobin for Infants With Single Ventricle?
In the setting of chronic hypoxemia, children with cyanotic congenital heart disease often develop an elevated hemoglobin (Hgb) level to achieve adequate oxygen delivery. Based on this physiologic adaptation, most congenital heart centers have adopted a strategy of red blood cell (RBC) transfusions to achieve higher serum Hgb concentration. Our institution has generally pursued an aggressive transfusion strategy. However, an “ideal” serum Hgb has not been defined and approaches to RBC transfusion vary significantly. We reviewed data from 59 patients with single ventricle physiology who underwent RBC transfusions between 12/07 and 4/09. The median age at transfusion was 25 days (range 1 to 334 days). One patient was post-Glenn anastomosis. Exclusion criteria included transfusions given within 72 hours of cardiac surgery or active bleeding. A total of 183 transfusions were identified and divided into terciles based upon pre-transfusion Hgb concentration in gm/dl - Group A (7.8–12.3), Group B (12.3–13.2), and Group C (13.2–15.7). 133 of the transfusions were given post-operatively at a median time of 19 days after surgery (range 3 to 72 days). Heart rates, blood pressures, arterial saturations, and cerebral near-infrared spectroscopy (cNIRS) values prior to transfusion were compared with values 1, 2, 4, 8, and 12 hours post-transfusion. The mean volume of transfusion was 14.7 ml/kg and mean increase in serum Hgb was 3.1 gm/dl. RBC transfusion produced the greatest hemodynamic benefit in those with serum Hgb ≤ 12.3 gm/dl (Table⇓). Of note, cNIRS, a reasonable surrogate for oxygen delivery, increased by almost 8% in Group A.
Conclusion. RBC transfusions can improve hemodynamics in infants with palliated single ventricle. We recommend transfusion when serum Hgb is <12 gm/dl, whereas RBC transfusion for subjects with Hbg > 13.2 may not be justified.