8/4/2019 TransfusionRBCs

1/2

Updated References: The ICU Book

RED BLOOD CELL TRANSFUSIONS

Increased Risk of Infection

Taylor RW, O'Brien J, Trottier SJ, et al. Red blood cell transfusions and nosocomialinfection in critically ill patients. Crit Care Med 2006;34:2302-2308.

[Link to Abstract] PMID: 16849995

Comment:One of the unheralded complications of red blood cell transfusions is

immunosuppression in the recipient (etiology unclear), which increases the risk ofinfection. A number of studies have shown that ICU patients who receive red blood cell

transfusions have a higher incidence of nosocomial infections, and the study by Taylor et

al provides further evidence for this association. This study included 2,000 medical andsurgical patients in one multidisciplinary ICU. Patients who were transfused with packed

red blood cells had a significantly higher incidence of nosocomial infections (14% vs6%) and a higher mortality rate (22% vs 10%) than nontranfused patients. Controlling forother variables revealed that red cell transfusions were an independent risk factor for

infection, with each unit transfused increasing the risk of infection by 10%. Removing

white blood cells from the donated blood did not reduce the risk of infection in the

recipient.

This study provides further evidence that RBC transfusions promote immunosupression

and an increased risk of infection._______________________________________________________________________

Benefit vs Risk

Hebert PC, Tinmouth A, Corwin HL. Controversies in RBC transfusion in the

critically ill. Chest 2007; 131:1583-1590. [Link to Abstract] PMID: 17494811

Comment:

About 90% of RBC transfusions in critically ill patients are used to correct anemia in

patients who are normovolemic and hemodynamically stable. However, this paper reveals

that there is no convincing evidence that this practice provides a benefit, eitherphysiologically or clinically. On the other hand, there is convinving evidence that RBC

transfusions are harmful, and one of the major sources of harm is immunosuppression

and an increased risk of nosocomial infections.

________________________________________________________________________Clinical Practice Guideline

Napolitano L, Kurek S, Luchette FA, et. al. for the American College of Critical Care

Medicine and the Eastern Association for the Surgery of Trauma Practice Management

Workgroup. Clinical practice guideline: Red blood cell transfusion in adult trauma

and critical care. Crit Care Med 2009;37:3124-3157. [Link to Abstract] PMID:

19773646

8/4/2019 TransfusionRBCs

2/2

Updated References: The ICU Book

Comment:

This guideline contains a total of 33 evidence-based recommendations that focusprimarily on the tranfusion of red blood cells to correct anemia in ICU patients who are

euvolemic and hemodynamically stable. Many of the recommendations are aimed at

limiting RBC transfusions because there is no evidence of benefit (either physiologicallyor clinically) and convincing evidence of harm associated with RBC transfusions to

correct anemia in patients who are hemodynamically stable. The specific

recommendations that deserve mention are listed below. Many of the recommendationsare stated exactly as they appear in the paper.

1. RBC transfusions based solely on the plasma hemoglobin level is a practice that

should be avoided. (This recommendation has appeared repeatedly over the past 25years, yet the plasma hemoglobin level continues to be the standard transfusion

trigger. In fact, many of the recommendations in this paper use the plasma

hemoglobin as a tranfusion trigger!!)

2. For anemic patients who are hemodynamically stable, a restrictive transfusion

strategy (transfuse when Hb < 7 g/dL) is as effective as a liberal transfusionstrategy (transfuse when Hb < 10 g/dL),except possibly in patients with acute

myocardial ischemia.

3. RBC transfusions may be beneficial in patients with acute coronary syndromes whenthe hemoglobin level is 8 g/dL on admission.

4. RBC transfusions should not be considered an effective method for improving tissueoxygen consumption in critically ill patients.

5. RBC transfusions should not be considered as a method to facilitate weaning frommechanical ventilation.

6. Unless there is active bleeding, RBC transfusions should be given as single units.

7. Transfusion-related acute lung injury has emerged as a leading cause of transfusion-

related morbidity and mortality. As such, all efforts should be made to avoid RBC

transfusions in patients at risk for acute lung injury (ALI) or acute respiratory distresssyndrome (ARDS).

8. RBC transfusion is associated with increased risk of nosocomial infection, and RBCtransfusion is an independent risk factor for systemic inflammatory response

syndrome (SIRS) and multiorgan failure (MOF).

9. RBC transfusions are independently associated with longer ICU and hospital length

of stay, increased complications, and increased mortality (Italics mine).

________________________________________________________________________