In the February 2013 issue of the British Journal of Haematology, Retter et al. summarize the current literature guiding the use of red cell transfusion in critically ill patients and provide recommendations to support clinicians in their day-to-day practice. The guidelines writing group was selected by the British Committee for Standards in Haematology (BCSH) Transfusion Task Force with input from the Intensive Care Society to provide expertise in relevant physiology, pathophysiology, general intensive care, and specific subgroups of critically ill patients.
For general intensive care patients, the following recommenations are set forth: “A transfusion threshold of 70 g/l or below, with a target Hb range of 70–90 g/l, should be the default for all critically ill patients, unless specific co-morbidities or acute illnessrelated factors modify clinical decision-making (Grade 1B)” and “Transfusion triggers should not exceed 90 g/l in most critically ill patients (Grade 1B).”
With regard to transfusion alternatives, “erythropoietin should not be used to treat anaemia in critically ill patients until further safety and efficacy data are available (Grade 1B)” and “in the absence of clear evidence of iron deficiency, routine iron supplementation is not recommended during critical illness (Grade 2D).” However, the use of blood sampling techniques to reduce iatrogenic blood loss is recommended: “The introduction of blood conservation sampling devices should be considered to reduce phlebotomy-associated blood loss (Grade 1C)”, and “pediatric blood sampling tubes should be considered for reducing iatrogenic blood loss (Grade 2C)”.
Specific recommendations are provided for transfusion practice in the following clinical settings: sepsis, neurological critical care, traumatic brain injury, subarachnoid hemorrhage, ischemic stroke, ischemic heart disease, and weaning from mechanical ventilation.