Percentage of pediatric patients ≥ 6 months to 18 years old who recieved a blood transfusion and had a valid hemoglobin or hematocrit value documented prior to transfusion.

Restrictive, laboratory‑guided transfusion is now the cornerstone of peri‑operative pediatric patient blood management (PBM). Children’s smaller circulating volumes, variable physiology, and heightened susceptibility to transfusion‑related lung injury amplify the harm of unnecessary transfusion. A 2025 review by Goobie and Faraoni¹ as well as the 2023 AABB international guidelines both emphasize that a pre-transfusion hemoglobin (Hb) or hematocrit (Hct) value is essential for safe intraoperative decision‑making and generally support a transfusion trigger near 7 g/dL in hemodynamically stable patients, with no proven benefit—and potential harm—above 10 g/dL.² Additionally, the 2024 German PBM review and SABM Standard 13 designate objective, age‑ and weight‑based Hb/Hct assessment as a core quality indicator for pediatric transfusions.^3,4 Missing pre‑transfusion labs has been recognized as a leading “error trap” that jeopardizes PBM programs.^5,6

TRAN‑03 converts this body of evidence into actionable quality improvement by requiring documentation of a valid Hb/Hct within 90 minutes before each intraoperative packed‑red‑cell dose ≥ 15 mL/kg in pediatric patients, with pragmatic exceptions for profound anemia (< 8g/dL or 24%) or massive hemorrhage. By aligning with evidence‑based thresholds, TRAN‑03 minimizes preventable exposure to transfusion‑related morbidity and promotes cost‑effective resource use.

Up to 36 hours prior to the first transfusion during the case

Pediatric patients  ≥ 6 months to 18 years of age who receive a transfusion of packed red blood cells intraoperatively

• Age < 6 months and ≥ 18 years 
• ASA 6 including Organ Procurement (CPT: 01990)
• Cardiac cases (determined by Procedure Type: Cardiac (pediatric) value codes 1 & 9)
• Massive Transfusion or blood loss: Defined as volume of 40mL/kg
• No intraoperative transfusion
• Obstetric cases (determined by Obstetric Anesthesia Type value codes > 0)

Documentation of hemoglobin and/or hematocrit within 90 minutes prior to each blood transfusion volume ≥ 15mL/kg

• Hemoglobin values reported in g/L are divided by 10 to convert to g/dL.
• Hematocrit values < 1 reported in L/L (liters of blood cells per liter of blood volume) are multiplied by 100
• Documentation of a Hgb/Hct value must be present within 90 minutes before each transfused volume of 15mL/Kg.
• Exceptions
  • If the Hgb/Hct was  < 8/24 within 36 hours of the first transfusion, 15mL/kg may be transfused without a lab check 
  • If the most recent hgb/hct drawn before the first transfusion is ≤ 5/16, a volume of ≤ 30mL/kg can be administered without a lab check.

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Not applicable

Provider(s) signed in at time of blood product administration

1. Goobie SM, Faraoni D. Perioperative paediatric patient blood management: a narrative review. Br J Anaesth. 2025;134(1):168‑179.

2. Carson JL, Stanworth SJ, Guyatt G, et al. Red blood cell transfusion: 2023 AABB international guidelines. JAMA. 2023;330(19):1892‑1902.

3. Wittenmeier E, Piekarski F, Steinbicker AU. Blood product transfusions for children in the perioperative period and for critically ill children. Dtsch Ärztebl Int. 2024;121(2):58‑65.

4. Society for the Advancement of Blood Management. Standard 13: Patient Blood Management for Pediatric Patients. In: SABM PBM Standards. 4th ed. SABM; 2024.

5. Warner LL, Thalji LB, Hunter Guevara LR, et al. Transfusion targets and adverse events in pediatric perioperative acute anemia. J Clin Anesth. 2024;94:111405.

6. Tan GM, Murto K, Downey LA, Wilder MS, Goobie SM. Error traps in pediatric patient blood management in the perioperative period. Paediatr Anaesth. 2023;33(8):609‑619.