Abstract
Red blood cell (RBC) transfusion is a common intervention in intensive care unit (ICU) patients. Anemia is frequent in this population and is associated with poor outcomes, especially in patients with ischemic heart disease. Although blood transfusions are generally given to improve tissue oxygenation, they do not systematically increase oxygen consumption and effects on oxygen delivery are not always very impressive. Blood transfusion may be lifesaving in some circumstances, but many studies have reported increased morbidity and mortality in transfused patients. This review focuses on some important aspects of RBC transfusion in the ICU, including physiologic considerations, a brief description of serious infectious and noninfectious hazards of transfusion, and the effects of RBC storage lesions. Emphasis is placed on the importance of personalizing blood transfusion according to physiological endpoints rather than arbitrary thresholds.
Highlights
Red blood cell (RBC) transfusion is commonly required in critically ill patients
Observational, multicenter studies reported that approximately one third of critically ill patients received a blood transfusion at one time or another during their stay in the intensive care unit (ICU) (Table 1)
We consider some key aspects of transfusion medicine in the ICU, focusing on aspects relevant to the critically ill patient, including prevalence and reasons for blood transfusion, epidemiology and etiology of anemia in these patients, pathophysiological considerations on tolerance to anemia, and efficacy of RBC transfusion
Summary
Red blood cell (RBC) transfusion is commonly required in critically ill patients. Several recent, observational, multicenter studies reported that approximately one third of critically ill patients received a blood transfusion at one time or another during their stay in the intensive care unit (ICU) (Table 1). Noninfectious serious hazards of transfusions The reasons for the apparent worse outcome of transfused compared with nontransfused critically ill patients may be found in several detrimental effects of transfused blood, globally referred to under the acronym “NonInfectious Serious Hazards Of Transfusion” or NISHOT (Table 2) [53] These include, among others, deleterious effects on the immune system (transfusion-related immunomodulation or “TRIM”) or on the cardiopulmonary system, e.g., transfusion-related acute lung injury ("TRALI”) [54] or transfusion-associated circulatory overload ("TACO”); the latter is currently the leading reported cause of transfusion-associated mortality [55].
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