Skip to main content

Volume 3 Supplement 1

ESICM LIVES 2015

Red cell transfusion in the critically ill patient

Introduction

It has been more than a decade since the TRICC trial established the concept of restrictive transfusion. The CRIT study subsequently showed that RBC transfusion may be an independent predictor of worse outcome. We undertook an audit to determine how our practice compares to the current evidence.

Methods

All ICU patients in the Victoria Infirmary receiving red blood cells between January 2013 and January 2014 were identified. The haemoglobin transfusion trigger was obtained from our clinical information system. The presence of bleeding, severe sepsis, ischaemic heart disease and traumatic brain injury were determined from our intensive care patient database and transfusion request forms.

Results

Red blood cells were issued a total of 124 times during the study period. In only 15 (12%) instances was the Hb trigger < 70g/L. The remaining 109 (88%) units transfused were at a Hb >70g/L. Within this high transfusion trigger group, there were 52 (48%) cases of bleeding, 67 (61%) cases of severe sepsis, 28 (26%) cases of ischaemic heart disease and 2 (2%) cases of traumatic brain injury. This left only 15 (12%) occasions where there appeared to be no clear justification for the decision to transfuse.

Conclusions

Despite the well recognized Hb trigger of 70g/L, there has been ambiguity regarding transfusion triggers in certain patients. New evidence is emerging to support restrictive transfusion in acute upper GI bleeding [1], septic shock [2] and traumatic brain injury [3]. Only 12% in our audit had no clear justification for transfusion but it is arguable that a restrictive strategy should have been used in these subgroups. Of note, 19 cases of severe sepsis also had coexisting coronary artery disease as did 8 cases of bleeding which were not limited to upper GI bleeding. In addition much of the evidence is so recent that it predates our audit but there is certainly a need for increased awareness of these new trials.

References

  1. Villanueva , et al: Transfusion strategies for acute upper gastrointestinal bleeding. NEJM. 2013, 368: 11-21. 10.1056/NEJMoa1211801.

    PubMed  CAS  Article  Google Scholar 

  2. Holst , et al: Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock. NEJM. 2014, 371: 1381-1391. 10.1056/NEJMoa1406617.

    PubMed  Article  Google Scholar 

  3. Robertson , et al: Effect of Erythropoetin and Transfusion Threshold on Neurological Recovery After Traumatic Brain Injury. JAMA. 2014, 312 (1): 36-47. 10.1001/jama.2014.6490.

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kersan, L., McGarvey, M., MacNeil, C. et al. Red cell transfusion in the critically ill patient. ICMx 3, A915 (2015). https://doi.org/10.1186/2197-425X-3-S1-A915

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/2197-425X-3-S1-A915

Keywords

  • Traumatic Brain Injury
  • Severe Sepsis
  • Ischaemic Heart Disease
  • Intensive Care Patient
  • Clinical Information System