Abstract
Anaemia is associated with inferior outcomes in critically ill patients. It is difficult to prevent and is treated commonly with the transfusion of packed red cells. However, transfusion to augment oxygen delivery has not been shown to consistently offer a survival advantage when the haemoglobin concentration exceeds 7 g/dL. Several studies point to inferior outcomes when patients are transfused. Observational studies have confirmed that critically ill patients have frequent blood draws as part of their routine daily care. Cumulatively large volumes of blood are frequently taken, which contribute significantly towards the development of anaemia. Reducing iatrogenic blood loss may reduce the risk of developing anaemia and possibly the need for transfusion. Blood conservation devices may help to achieve this goal. The integration of blood conservation devices into routine care has been relatively slow in critical care. This review summarises the current evidence base and confirms that blood conservation devices do reduce the volume of iatrogenic blood loss. In the most recent studies, these devices have been shown to reduce transfusion requirements even in those intensive care units that follow a restrictive transfusion strategy.
Highlights
Anaemia and the transfusion of allogenic red blood cells (RBC) are common in the critically ill [1,2]
The Transfusion Requirements After Cardiac Surgery (TRACS) study found no difference in a composite end-point of 30-day mortality and severe comorbidity in cardiac patients prospectively randomized to a liberal or restrictive transfusion strategy [16]
This review explores the contribution of phlebotomy to the development of anaemia in the critically ill and examines the role that blood conservation devices may have in its prevention
Summary
Anaemia and the transfusion of allogenic red blood cells (RBC) are common in the critically ill [1,2]. The Transfusion Requirements After Cardiac Surgery (TRACS) study found no difference in a composite end-point of 30-day mortality and severe comorbidity in cardiac patients prospectively randomized to a liberal or restrictive transfusion strategy [16]. A survey in 2001 found that only 18% of adult ICUs in England and Wales use blood conservation devices [20] The reasons for this are not clear but may relate to the cost or a lack of evidence that such devices reduce transfusion requirements. This review explores the contribution of phlebotomy to the development of anaemia in the critically ill and examines the role that blood conservation devices may have in its prevention. 1. Is there evidence that blood conservation devices reduce the volume of blood taken from critically ill patients?. Do blood conservation devices have an effect in reducing the number of catheter-related blood stream infections?
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