Transfusion Requirements in Anesthesia and Intensive Care

Abstract

Allogeneic blood products are commonly used in perioperative and critically ill patients. This review focuses on the current evidence and emerging data relating to modern transfusion strategies in these patients. Several large randomized trials and meta-analyses found no inferiority of a restrictive strategy as compared to a liberal one in red blood cell (RBC) transfusion. The storage duration of transfused RBC seems to have a minor, if any, impact on patients’ outcome. However, patients requiring massive transfusions might be an exception. The indications and benefits of plasma and platelets transfusions are less clear because robust clinical evidence is missing. In contrast to the established evidence and practice for RBC transfusion, the limited evidence for plasma and platelets transfusions call for incorporating expert opinions and guidelines and for standardized local practice. Targeted hemostatic interventions are preferred over prophylactic fixed-ratio transfusions in terms of efficacy and avoidance of transfusion-related complications.