Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients

Tinmouth, Alan; McIntyre, Lauralynn A.; Fowler, Robert

doi:10.1503/cmaj.071298

Cited by 57 publications

(49 citation statements)

References 73 publications

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“…Often cited causes include frequent blood draws (the so-called "medical vampire") (35), decreased erythropoietin production and responsiveness (36 -38), nutritional deficits, alterations in iron metabolism (39,40), increased RBC destruction, occult (e.g., gastrointestinal bleeding) or overt blood loss, and bone marrow suppression (34,41). Although various blood conservation strategies are available in the critically ill populations (42,43), nearly three fourths of all critically ill patients with an ICU stay of Ͼ7 days receive an RBC transfusion (2). Many of these transfusions may be inappropriate.…”

Section: Anemia and Blood Utilization In The Icu Settingmentioning

confidence: 99%

Red blood cell transfusion in critically ill children: A narrative review*

Istaphanous

Wheeler

Lisco

et al. 2011

Pediatric Critical Care Medicine

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The available evidence does not support the extensive use of RBC transfusions in general or critically ill patients. Transfusions are still associated with risks, and although their benefits are established in limited situations, the associated negative outcomes in many more patients must be closely addressed. Given the frequency of anemia and its proven negative outcomes, transfusion decisions in the critically ill children should be based on individual patient's characteristics rather than generalized triggers, with consideration of potential risks and benefits, and available blood conservation strategies that can reduce transfusion needs.

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Section: Anemia and Blood Utilization In The Icu Settingmentioning

confidence: 99%

Red blood cell transfusion in critically ill children: A narrative review*

Istaphanous

Wheeler

Lisco

et al. 2011

Pediatric Critical Care Medicine

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show abstract

“…These include the use of haemostatic agents, Hb substitutes, blood salvage techniques, reducing blood loss from diagnostic testing, using erythropoietin and lowering the level of Hb needed to justify transfusion 28. A recent international consensus has recommended that blood transfusion should be administered to NV-UGIB patients with a Hb level of 70 g/l or less, while weighing the risks of adverse outcomes associated with anaemia against the potential side effects of transfusion in the particular case 29…”

Section: Discussionmentioning

confidence: 99%

Mortality following blood transfusion for non-variceal upper gastrointestinal bleeding

Taha

McCloskey

Craigen

et al. 2011

Frontline Gastroenterol

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Objective Blood transfusion remains an integral step in the management of acute non-variceal upper gastrointestinal bleeding (NV-UGIB), but its safety is being increasingly questioned in less severe cases. The authors aimed to measure 30-day and 2-year mortalities after blood transfusion for NV-UGIB. Methods Cox proportional hazards models were used to estimate the association of blood transfusion with mortality while adjusting for age, Charlson comorbidity score, the complete Rockall score for acute UGIB, admission status and medication intake prior to bleeding. Main outcome measures Death from any cause at 30 days and 2 years after NV-UGIB. Results 1340 patients presented with NV-UGIB (808 men (60.3%), median age 67 years) of whom 564 (42.1%) were transfused. The overall mortality was 5.3% at 30 days and 26.0% at 2 years in all patients. Comparing subjects with a haemoglobin concentration greater than 10.0 g/dl who were transfused with those who were not, 30-day mortalities (95% CIs) were 11.5% (6.7 to 18.0) versus 3.6% (2.3 to 5.3), respectively, p<0.001, and 2-year mortalities (95% CIs) were 40% (32 to 49) versus 20% (17 to 23), p<0.001. After adjusting for age, Charlson score, Rockall score and haemoglobin, the HRs (95% CIs) for death after transfusion were 1.88 (1.00 to 3.55) (p=0.051) at 30 days and 1.71 (1.28 to 2.28), (p<0.001) at 2 years. Conclusion In patients with moderately severe NV-UGIB, mortality is higher following blood transfusion. Whether this refl ects selection bias, an effect of comorbidity or an effect of transfusion requires urgent prospective study.

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“…La première étape d'une stratégie d'épargne transfusionnelle est probablement de réduire le vampirisme médical lié aux prélèvements sanguins. Outre une prescription raisonnée des examens biologiques, l'utilisation d'un système de réinjection de la purge sur la ligne artérielle ou de tubes d'examens à volume réduit ou de tubes pédiatriques peuvent permettre de diminuer la spoliation sanguine voire de diminuer le recours à la transfusion de CGR [88][89][90][91]. L'utilisation d'EPO, souvent associée à une supplémenta-tion martiale, a été proposée afin de limiter le recours à la transfusion de CGR en réanimation, sur la base des excellents résultats obtenus chez les patients insuffisants rénaux et d'observations expérimentales d'inhibition de l'apoptose des progéniteurs érythroïdes obtenus chez des patients de réanimation [10].…”

Section: Espoirs Et Déceptions Des Stratégies D'épargne Transfusionnelleunclassified

“…Les perfluorocarbones nécessitent pour être efficaces une ventilation en FiO 2 =1. À l'heure actuelle et en dehors d'études cliniques chez le polytraumatisé ou en contexte chirurgical, la commercialisation de ces produits de substitution est limitée à quelques pays [1,89].…”

Section: Espoirs Et Déceptions Des Stratégies D'épargne Transfusionnelleunclassified

Transfusion de concentrés globulaires en réanimation : moins, c’est mieux !

Champigneulle

Pène

2014

Réanimation

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Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients

Cited by 57 publications

References 73 publications

Red blood cell transfusion in critically ill children: A narrative review*

Red blood cell transfusion in critically ill children: A narrative review*

Mortality following blood transfusion for non-variceal upper gastrointestinal bleeding

Transfusion de concentrés globulaires en réanimation : moins, c’est mieux !

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