Red blood cell transfusions are a common therapy in critically ill anemic children ,a packed cell product is the component of choice for replacement therapy during RBC loss  and sporadic transfusion therapy.
The decision to transfuse must be based on an assessment of the risks of anemia versus the risks of transfusion. In addition to the individual assessment of any symptomatic anemic child, the duration of anemia must be taken into consideration as well as the extent of trauma or surgery and the probability of blood loss and coexisting conditions such as impaired pulmonary function and inadequate cardiac output. ^(1-3)
This study was a prospective observational study conducted for one year in Pediatric Intensive Care Unit (PICU) of SohagUniversity Hospital ,a tertiary health center which provide specialized care to critically ill  infants and children with about 400 admissions yearly.Patients was divided to two groups according to arterial blood pressure.                 
Stable critically ill: not hypotensive (mean arterial pressure not less than 2 standard deviations below the mean for age), or no cardiovascular support for at least two hours prior to enrollment.                                                                                                                
Unstable critically ill: hypotensive (mean arterial pressure less than 2 standard deviations below the mean for age), or there is cardiovascular support for at least two hours prior to enrollment, this includes patients with heart failure.                                    
Packed RBCS transfusion following  arestrictive blood transfusion strategywas used.
Stable critically ill patients: received blood transfusion only if hemoglobin concentration falls below 7 gm/dl.                                                                                       
Unstable critically ill patients: received blood transfusion according to clinical judgment.^(1,4)                                                                                                                                                             
Short term outcome till discharge including (mortality or improvement) and duration of ICU stay was observed and recorded.                                                                                 
Our study showed that respiratory diseases were the main risk factor that increase the duration of PICU stay (p value 0.001),while suffering from hemodynamic unstablity was the main risk factor for death in our PICU (P value 0.02) .a restrictive blood transfusion strategy was safe in pediatric patients whose  condition was stable in PICU, with no effect on mortality or duration of admission in PICU andthe studywas not able to highlight a cause-effect relationship between RBC transfusions and outcomes in critically ill children.