Blood Transfusion Practice in Critically Ill Patients and Clinical Outcomes

Abstract

Aim:The aim of this study is to quantify the red blood cell (RBC) transfusion threshold in critically ill patients and to examine the relationship between RBC transfusion and clinical outcomes. Materials and Methods:Five hundred and twenty patients who were admitted to the internal medicine intensive care unit (ICU) between February 2018 and May 2019 were included in this study. The collected data included patients' demographic characteristics, admission diagnostic categories, co-morbidities, the ICU admission Simplified Acute Physiology Scores (SAPS) II, numbers of RBC transfusion, ICU admission and pretransfusion hemoglobin levels, and requirements of invasive mechanical ventilation and vasoactive drugs during the ICU stay. The primary endpoint of the study was to determine the RBC transfusion threshold in critically ill patients. Secondary outcomes were the ICU length of stay and mortality.Results: A total of 89 (17.1%) patients received RBC transfusion during the ICU stay. The transfusion threshold hemoglobin was 6.9 g/dL in transfused patients. Transfused patients had higher SAPS II scores at ICU admission than non-transfused patients (p<0.001). The number of patients requiring invasive mechanical ventilation and vasopressor support was higher in transfused patients (p<0.001). ICU mortality rates were higher in patients who had received RBC transfusion during the ICU stay than in those who did not (ICU mortality rates were 51.7% and 23.9%, respectively). Conclusion:This study showed that one-fifth of ICU patients received RBC transfusion during the ICU stay. Transfused patients had higher disease scores and lower hemoglobin levels on the day of ICU admission. Transfused patients stayed longer in the ICU and had higher mortality rates than non-transfused patients.

Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial

“…A prior meta-analysis concerning RBC transfusion in trauma patients revealed that increased RBC transfusion heightened the odds of experiencing multiple organ failure and acute lung injury [ 20 ]. Another study indicated that patients in the internal medicine ICU who underwent transfusion had extended ICU stays [ 21 ]. Although we do not have a clear explanation, there were no significant differences in complications or organ failure between the two strategies; however, there was a marked difference in ICU-free or ventilator-free days.…”

Intensive Strategy Resuscitation of Hemorrhagic Shock Patients with Ectopic Pregnancy in the Intensive Care Unit: A Case Report

“…When a patient is admitted into the ICU, shock and physiological alterations must be identified and corrected. 7,13,14 European Society of Intensive Care Medicine recommendations for blood transfusion in intensive care Units is given with a high ratio transfusion strategy (at least one unit of plasma per 2 units of packed red blood cells) vs. a low ratio transfusion strategy in critically ill patients with massive bleeding from trauma. 6 The observational trauma evidence suggests high transfusion ratios ranging from 1:1 to 1:2 fresh frozen plasma (FFP): RBC results in a large mortality benefit early on.…”