Red cell transfusion practice following the transfusion requirements in critical care (TRICC) study: prospective observational cohort study in a large UK intensive care unit.
OBJECTIVE
The Transfusion Requirements In Critical Care (TRICC) study found that critically ill patients tolerate a restrictive haemoglobin transfusion threshold. We investigated red-cell transfusion practice since publication of the TRICC study in a large Scottish teaching hospital intensive care unit (ICU).


METHODS
We prospectively collected daily data for a 6-month period on haemoglobin concentrations, red-cell transfusions and indications for transfusions, throughout ICU stay for all patients who stayed for longer than 24 h in the ICU.


RESULTS
A total of 176 patients were studied, who utilized 1237 ICU days. Of these 176 patients, 52% received red-cell transfusions. A haemoglobin concentration of < or = 9 g/dl was measured in 55% of patients; this occurred by day 1 and day 2 in 52% and 77% of these cases, respectively. Overall the haemoglobin concentration was < or = 9 g/dl for 45% of all patient days. Total red-cell use was 3.1 units per admission (0.47 units per patient day). Only 18% of transfusion episodes were required as a result of haemorrhage. For 'non-haemorrhage' transfusion episodes, the median pretransfusion haemoglobin concentration was 7.8 g/dl (interquartile range: 7.4-8.4 g/dl), and 64% of transfusion episodes were for 2 units.


CONCLUSIONS
Clinicians in our centre were conservative, in keeping with recent transfusion guidelines, but deviated from the TRICC protocol by transfusing at haemoglobin concentrations of between 7 and 9 g/dl, rather than below 7 g/dl, and by prescribing 2 unit transfusions. Significant numbers of red-cell units are still used in the critically ill.
Chohan
S S
SS
Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary, Edinburgh, UK.
McArdle
F
F
McClelland
D B L
DB
Mackenzie
S J
SJ
Walsh
T S
TS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D006113:United Kingdom
D006454:Hemoglobins