Red blood cell transfusion in the critically ill patient has been and continues to be surrounded by controversy and lack of hard data. Up to 90 percent of transfusions in the ICU are given for anemia, an indication which is least supported by the data. The joint taskforce of EAST, ACCM and SCCM has published a clinical practice guideline which outlines recommendations and rationale. These recommendations are summarized as follows:
RBC transfusion is indicated for patients with evidence of hemorrhagic shock.
RBC transfusion may be indicated for patients with acute hemorrhage and hemodynamic instability or inadequate DO2.
Transfusion triggers for Hb<7 are as effective as those for Hb<10 in hemodynamically stable critically ill patients, except for those with AMI or USA.
Hb used as a sole trigger is not advised; transfusion decisions should be based on intravascular volume status, evidence of shock, duration and extent of anemia, and cardiopulmonary physiologic parameters.
Consider RBC transfusion if Hb<7 in resuscitated critically ill patients, patients who are being mechanically ventilated or critically ill patients with stable cardiac disease.
RBC transfusion should not be considered as an absolute method to improve tissue oxygen consumption in critically ill patients.
RBC transfusion may be beneficial in patients with acute coronary syndromes with Hb<8 on hospital admission.
References
Napolitano LM et al: Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care: Crit Care Med 2009;37:3124-3157
