Transfusion Practices and Outcomes in Pediatric Patients with Severe Anemia: A Single-Center Retrospective Study

Background: Severe anemia in pediatric patients remains significant cause of morbidity and mortality, with blood transfusion serving as critical life-saving intervention. This study aimed to analyze transfusion practices and clinical outcomes in children presenting with severe anemia at tertiary care center. Methods: This retrospective observational study included 284 pediatric patients aged 1 month to 12 years with severe anemia (hemoglobin ≤7 g/dL) who received packed red blood cell transfusion between January 2023 and December 2025. Demographic characteristics, etiological profile, transfusion details, and clinical outcomes were analyzed. Multivariate logistic regression identified independent predictors of prolonged hospitalization. Results: The median age was 3.8 years (IQR: 1.5-7.2) with male predominance (58.1%). Children under five years constituted 63.4% of the cohort. Nutritional deficiency anemia was leading etiology (41.5%), followed by hemolytic anemias (22.2%) and malaria-associated anemia (12.3%). Mean pre-transfusion hemoglobin was 4.8±1.4 g/dL, increasing to 7.9±1.6 g/dL post-transfusion, with adequate response in 78.5% of patients. Transfusion reactions occurred in 9.9% of cases, predominantly febrile non-hemolytic reactions. Median hospital stay was 6 days. Overall mortality was 3.5%, with symptom resolution in 94.5% of survivors. Cardiac decompensation (aOR 2.84), bone marrow failure (aOR 4.12), hemoglobin ≤4 g/dL (aOR 1.98), and multiple transfusion requirements (aOR 2.56) were independent predictors of prolonged hospitalization.