RBC Transfusion in the ICU

Is There a Reason?

¹ From the Critical Care Service and the Departments of Anesthesiology and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Objective: To evaluate RBC transfusion practice in the ICU.

Design: Retrospective chart review.

Setting: Multidisciplinary ICU in a tertiary care center.

Patients: All patients admitted to the ICU with a length of stay of greater than 1 week.

Results: A total of 23% of all patients admitted to the ICU had a length of stay of greater than 1 week (19.6±1.6 days). Of these patients, 85% received blood transfusions (9.5±0.8 U per patient). These transfusions were not solely a function of acute blood loss. Patients were transfused a constant 2 to 3 U/wk. Patients receiving blood transfusions were phlebotomized on average 61 to 70 mL per day. Phlebotomy accounted for 49% of the variation in amount of RBCs transfused. No indication for blood transfusion was identified for 29% of transfusion events. A low hematocrit (<25%) was the only identifiable indication in an additional 19% of events. Almost one third of all RBCs transfused were without a clear transfusion indication.

Conclusion: The long-term ICU population receive a large number of blood transfusions. Phlebotomy contributes significantly to these transfusions. There is no clear indication for a large number of the blood transfusions given. Many blood transfusions appear to be administered because of an arbitrary "transfusion trigger" rather than a physiologic need for blood. Blood conservation and adherence to transfusion guidelines could significantly reduce RBC transfusion in the ICU.

Key Words: blood transfusion • ICU anemia • transfusion guidelines • transfusion indication • transfusion trigger

Submitted on September 26, 1994
Accepted on February 1, 1995

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