Percentage of pediatric patients ≥ 6 months to 18 years old with a post transfusion hemoglobin or hematocrit value greater than or equal to 10 g/dL or 30%.

Restrictive, laboratory‑guided transfusion is now the cornerstone of perioperative 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‑04 converts this body of evidence into actionable quality improvement by requiring postoperative Hb/Hct  values to not exceed 10 g/dL or 30%, with pragmatic exceptions for profound anemia (< 8g/dL or 24%) or massive hemorrhage. By aligning with evidence‑based thresholds, TRAN‑04 minimizes preventable exposure to transfusion‑related morbidity and promotes cost‑effective resource use

90 minutes before the last intraoperative transfusion to 18 hours after Anesthesia End

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)

Hematocrit value ≤ 30% or hemoglobin ≤ 10 g/dL value documented within 18 hours after Anesthesia End.

• All hemoglobin/hematocrit lab values drawn after the last transfusion and within 18 hours after anesthesia end will be evaluated. If the lowest of these values is ≤10g/dL or ≤30%, the case will pass.
• If no Hgb/Hct checked within 18 hours after Anesthesia End time, the case will fail
• If the hemoglobin or hematocrit at the time of the last transfusion (within 90 minutes before) is less than or equal to 8/24, the case will pass.
• Hemoglobin values reported in g/L are divided by 10 to convert to g/dL.
• Hematocrit values < 1 reported in L/L (liter of blood cells per liter of blood volume) are multiplied by 100

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

Pending

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.