RBC transfusion in the ICU. Is there a reason?
OBJECTIVE
To evaluate RBC transfusion practice in the ICU.


METHODS
Retrospective chart review.


METHODS
Multidisciplinary ICU in a tertiary care center.


METHODS
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.


CONCLUSIONS
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.
Corwin
H L
HL
Critical Care Service, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Parsonnet
K C
KC
Gettinger
A
A
D001815:Bloodletting; D016022:Case-Control Studies; D003422:Critical Care; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006400:Hematocrit; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies