In order to elucidate whether data from transfusion trials has impacted current intensive care transfusion management, de Bruin and colleagues performed an online, anonymous, worldwide survey among ICU physicians, evaluating red blood cell, platelet and plasma transfusion practices.
Of 725 completed surveys, a hospital transfusion protocol was available in 53%, with only 29% using ICU-specific transfusion guidelines. The reported haemoglobin threshold for the general ICU population was 7 g/dL. Higher transfusion thresholds were cited for ECMO and brain injured patients (8 g/dL [7.0–9.0]). Platelets were transfused at 20 x 10(9) cells/L (IQR 10-25) in asymptomatic patients, and at a higher count prior to invasive procedures. Plasma transfusion practice was highly variable. Anaesthesiologists transfused more liberally than internal medicine physicians.
The author’s work would indicate that red cell transfusion practice for the general ICU population is restrictive, with higher levels targeted in those with brain injury and on ECMO. Plasma and platelet transfusion practice varies.
– Jill M. Cholette (SABM reviewer)