Transfusion of Red Blood Cells to Patients with Sepsis.

Yi-Ling Chan,Chin-Chieh Wu,Chih-Huang Li,Kuan-Fu Chen,Shih-Tsung Han

doi:10.3390/ijms18091946

Abstract

Sepsis is one of the major causes of death worldwide, and is the host response to infection which renders our organs malfunctioning. Insufficient tissue perfusion and oxygen delivery have been implicated in the pathogenesis of sepsis-related organ dysfunction, making transfusion of packed red blood cells (pRBCs) a reasonable treatment modality. However, clinical trials have generated controversial results. Even the notion that transfused pRBCs increase the oxygen-carrying capacity of blood has been challenged. Meanwhile, during sepsis, the ability of our tissues to utilize oxygen may also be reduced, and the increased blood concentrations of lactate may be the results of strong inflammation and excessive catecholamine release, rather than impaired cell respiration. Leukodepleted pRBCs more consistently demonstrated improvement in microcirculation, and the increase in blood viscosity brought about by pRBC transfusion helps maintain functional capillary density. A restrictive strategy of pRBC transfusion is recommended in treating septic patients.

Highlights

Sepsis claims more than 200,000 lives annually in the United States [1]—more than prostate cancer, breast cancer, and acquired immunodeficiency syndrome combined [2]
Severe sepsis denotes sepsis accompanied by organ dysfunction, and septic shock denotes sepsis-induced hypotension that cannot be reversed by intravenous fluid resuscitation
As early goal-directed therapy (EGDT) seemed promising in lowering mortality in septic patients with shock or hyperlactatemia, many questioned the necessity of packed red blood cells (pRBCs) transfusion to increase oxygen delivery

Summary

Introduction

Sepsis claims more than 200,000 lives annually in the United States [1]—more than prostate cancer, breast cancer, and acquired immunodeficiency syndrome combined [2]. Sepsis is the major cause of death for patients in the intensive care unit [3]. Packed red blood cell (pRBC) transfusion has been incorporated into the recommended treatment bundle of sepsis since 2004 [4]. This review discusses the rationale of pRBC transfusion during sepsis, its efficacy, and concerns that this practice has generated

Sepsis

Have Transfused RBCs Increased Oxygen Delivery?

Does the Tissue Need More Oxygen during Sepsis?

Findings

Conclusions