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Liver transplantation (LT) is the standard treatment for children with end-stage chronic liver disease (CLD). Packed red blood cell (PRBC) transfusions are often needed to manage anemia pre- and post-LT, as well as blood loss during LT surgery. However, transfusions can increase sensitization risks, leading to adverse outcomes. 1 2 This retrospective study aimed to assess the incidence of PRBC transfusions in children with CLD during the perioperative period at a UK LT center. Since anemia is common in these children,3 a secondary aim was to investigate if they were screened for nutritional anemia and treated for deficiencies before transplantation.The study included children with CLD who underwent LT between June 2021 and February 2023. One child was excluded due to care being transferred to another center. Children listed for acute liver failure or hepatoblastoma were excluded.Data was collected at three points: perioperative (from listing for LT to surgery), intraoperative (during surgery), and postoperative (up to 28 days post-LT). Screening for nutritional anemia included iron studies, vitamin B12, and folic acid levels, using laboratory age-specific reference ranges for hemoglobin and mean corpuscular volume (MCV). Data was sourced from medical and blood bank records.Among 29 children analyzed, the median wait time for LT was 49.5 days (range: 1–254 days), with 48% (n=14) being female. Biliary atresia was the most common underlying cause (48%, n=14).Of the patients, 27 were anemic. PRBC transfusions were needed in 10% (n=3) preoperatively, 89% (n=26) intraoperatively, and 58% (n=17) postoperatively. None of the transfusions in the preoperative or postoperative periods were due to bleeding.In the preoperative period, one of the three children requiring PRBC transfusions was screened for iron deficiency anemia (IDA) and found deficient; however, no iron supplements were given. None of these patients were screened for vitamin B12 or folic acid deficiency.Table 1 shows the results of nutritional anemia screening and supplementation if deficient. Ferritin levels were tested in 10 children, with 9 showing normal levels. One child with low ferritin had IDA based on iron studies but normal MCV.This study reports the incidence of PRBC transfusions and inadequate screening for nutritional anemia in children with CLD undergoing LT. MCV and ferritin levels alone are insufficient for diagnosing nutritional anemia. Iron studies, along with vitamin B12 and folate assessments, may help differentiate anemia of chronic disease and nutritional anaemia and may help reduce PRBC transfusions preoperatively.Abstract OC56 Table 1Screening and treatment of children with anemia while awaiting liver transplant n=27 Screened with iron studies IDA/treated Screened for Vitamin B12 deficiency Vitamin B12 deficient/treated Screened for Folate deficiency Folate deficient/treated Low Hb & low MCV(n=4) 2 2/1 2 0/0 2 1/0 Low Hb & normal MCV(n=20) 13 3/2 7 0/0 11 6/3 Low Hb & High MCV(n=3) 0 0/0 1 0/0 1 0/0 Hb: Hemoglobin, MCV: Mean Corpuscular Volume, IDA: Iron deficient anemiaReferences Tran LT, Mazariegos GV, Damian D. Red blood cell transfusion in pediatric orthotopic liver transplantation. Anesthesia & Analgesia 2019 Oct;129(4):1087–92.Raj Nath Makroo, Agrawal S, Chowdhry M. Red cell alloimmunization & role of advanced immunohaematological support in liver transplantation. DOAJ (DOAJ: Directory of Open Access Journals) 2017 Apr 1;145(4):488–91.Zareifar S, Dehghani SM, Rahanjam N. Prevalence of iron deficiency anemia in children with liver cirrhosis: a cross-sectional study. Int J Hematol Oncol Stem Cell Res. 2015 Jul 1;9(3):128–32.