When it comes to blood transfusions, more isn’t always better, notes Johns Hopkins Children’s Center pediatric anesthesiologist Dheeraj Goswami.

As a medical resident at Johns Hopkins, Goswami knew that studies in adults showed that blood products can cause harm for some patients, ranging from mild to severe and even life-threatening. Much of that work had been led by Johns Hopkins anesthesiologist Steven Frank, a world-renowned expert in blood conservation. For more than a decade, Frank has been conducting research — and raising awareness within the surgical community — around a critical tenet: Blood saves lives when you need it but only increases risks and costs when you don’t.

“But nobody was focusing on blood conservation when it came to the pediatric population,” says Goswami, now an assistant professor of anesthesiology and critical care medicine at Johns Hopkins and director of pediatric cardiac anesthesia.

So together with former Johns Hopkins pediatric anesthesiology resident Branden Engorn, Goswami set out to shed new light on any potential risks associated with blood transfusions in pediatric surgical patients. They focused on cardiac surgery patients since they receive the most blood products within the hospital.

In a retrospective study examining more than 30,000 pediatric patients that built on earlier smaller studies, Goswami and colleagues found an association showing that young patients transfused to a higher level had higher rates of postoperative complications — including adverse outcomes such as stroke and thrombosis formation.

“The paper made the cover of one of our anesthesiology journals (Anesthesia & Analgesia/November 2021) and brewed some excitement in the field,” says Goswami, “because it could potentially lead to a change in practice — or at least to clinicians reconsidering their transfusion approaches in some pediatric patients.”

It also generated some pushback, he notes. An editorial in the same issue of the journal took pains to note that the study showed only an association between higher hematocrit levels and increased complications — not causation.

For his part, Goswami acknowledges that further studies will be needed but he does feel comfortable concluding that “we should at least be judicious about not giving blood just to reach a prescribed hemoglobin level.”