Review of Current Practice of Blood and Component Transfusion: Critical Issues for the Critically Ill Patient

Abstract

Major haemorrhage continues to be a leading cause of morbidity and mortality in a number of situations such as trauma, ruptured aneurysms, obstetrics, liver transplantation and gastrointestinal blood loss.1 In modern day clinical practice, clinicians have a range of blood components and specific clotting products at their disposal in the management of such patients. However, recent evidence is driving change in the optimal management of coagulopathy in major haemorrhage. The critically ill patient often exhibits deranged coagulation as assessed by laboratory tests. It is unclear the extent to which this is an epiphenomenon, and to what extent coagulation requires correction prior to either bedside or surgical intervention. There is increasing evidence to suggest that blood and component transfusions carry significant though poorly quantified risks. It is therefore prudent to exercise a selective approach to transfusion, avoiding ‘correction of the numbers’ when the risk of clinically important bleeding is small. In this article, we review current UK practice and evidence for use of blood and its components in the ICU setting. We also appraise more recent concepts such as the new coagulation model, acute coagulopathy of trauma and novel treatment strategies. We will discuss current guidelines and recommendations, and highlight potential areas for future research.