Indication of transfusion of blood components in paediatric and neonatal patients in India: Real-world multicentre data

Background and Objectives: Globally, there is high variability in paediatric transfusion practices. As per the World Health Organization (WHO), the majority of transfusions in low-income countries are administered to children under 5 years. This study aimed to characterize the epidemiology and indications for blood component transfusions among neonatal and paediatric patients across India. Materials and Methods: A prospective longitudinal multicentre study was conducted over 6 months (April–September 2022). Standardized data sheets captured age, gender, diagnosis, transfusion indication, component type and first versus repeat transfusion status for all paediatric requests. Results: Twenty-three medical institutions (combined 32,759 beds) participated in the study. Among 396,092 total blood component requests, 52,658 (13.2%) were for paediatric patients. Most were male (60.1%), aged 5–12 years (26.4%), and 42.7% required >1 transfusion. Red cell components were the most frequently requested (68%), followed by platelets (17.5%) and plasma (12.3%). Medical indications accounted for 67.6% requests, followed by 30.3% surgical indications. Haematology (48%), oncology (17.1%) and infections (10.5%) were the most common medical indications; however, cardiac surgeries (44.2%) and gastrointestinal surgeries (30%) were the most common surgical indications. Haemoglobinopathies (21.4%) were overall the most common indication for the transfusions reported. Conclusion: Paediatric patients accounted for over 13% of all transfusion requests, predominantly for red cells and medical indications (mainly haemoglobinopathy). This represents the first large-scale epidemiological assessment of paediatric transfusion indications in India and establishes foundational evidence to guide understanding of blood utilization trends in children as well as indicate priority research areas for the future.