Latest Updates on Transfusion in the Critically Ill

Blood transfusions are common in critically ill patients, with 2 in 5 adults admitted to an ICU receiving a transfusion. The Critical Care NetWork will cite some of the key references in the debate on restrictive thresholds for transfusions and their association with improved outcomes.

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  1. Credit: Wellcome Images, London
    Credit: Wellcome Images, London
  2. The CRIT Study: Anemia and blood transfusion in the critically ill--current clinical practice in the United States
  3. A prospective, multicenter, observational cohort study of U.S. ICU patients found that 44% of patients received one or more transfusions while in the ICU and that transfusions were independently associated with worse outcomes. The number of RBC transfusions was independently associated with longer ICU and hospital lengths of stay and an increase in mortality. Patients who received transfusions also had more total complications and were more likely to experience a complication.
  4. Anemia and Blood Transfusion in Critically Ill Patients
  5. This prospective, multicenter, observational European cohort study found that 37% of patients received one or more transfusions while in the ICU and that transfusions were independently associated with worse outcomes including mortality and organ system failure.
  6. Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock
  7. This randomized trial of 998 adult patients with septic shock that compared high (Hb < 9 g/dL) vs low (Hb < 7 g/dL) thresholds for transfusion found no differences in outcomes (including mortality) in those with lower transfusion threshold. This trial suggested that lower transfusion thresholds are safe in septic patients.
  8. Transfusion Strategies for Patients in Pediatric Intensive Care Units
  9. A randomized trial of 637 critically ill children compared liberal (Hb < 9 g/dL) vs conservation (Hb < 7 g/dL) thresholds for transfusion. The trial also found no differences in outcomes (including mortality) in those with more restrictive transfusion threshold. This suggests that lower transfusion thresholds are safe in critically ill children.
  10. Age of Transfused Blood in Critically Ill Adults
  11. A multicenter randomized blinded trial in over 2,400 critically ill patients in 64 centers compared new blood (mean storage (±SD) of 6.1±4.9 days) versus old blood with storage of 22.0±8.4 day (P<.001). There was no statistically significant difference in 90-day mortality.
  12. Transfusion of fresher vs older red blood cells in hospitalized patients
  13. This meta-analysis of 12 trials and 5,229 patients compared “fresh blood” or blood stored for 3 to 10 days to “older blood” stored for longer durations. Results found that there was no difference in mortality and no difference in adverse events, such as acute transfusion reactions, when comparing the two groups.
  14. Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion
  15. This randomized trial compared outcomes in 20,858 hospitalized patients transfused with fresh blood (mean storage time 13.0±7.6 days) to older blood (mean storage time 23.6±8.9 days). Results showed no differences in mortality when comparing those transfused with fresh vs old blood (8.7% vs 9.1%). Additionally, there was no difference when examining the predetermined subgroups including those undergoing cardiovascular surgery, those with cancer, and those admitted to the ICU.
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