The transfusion of red blood cells in the ICU remains a hot topic not only since the CRIT study and TRICC trial. It has been associated with complications and worse outcome. Unfortunately anemia and bleeding are common problems in critical care and therefore transfusions remain an important tool in the treatment in these patients, especially as we know that anemia itself is harmful. The question still remains when and in which situations RBC transfusions are indicated and helpful, especially in patients with coronary heart disease (CHD).
The TRICC trial in the NEJM in 1999 concluded: ‘A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients, with the possible exception of patients with acute myocardial infarction and unstable angina’. The clinical practice guidelines from the AABB in 2012 noted that they can not recommend for or against a liberal or restrictive transfusion threshold for stable patients with acute coronary syndrome
Now JAMA addresses the issue of transfusion in patients with CHD undergoing percutaneous intervention (PCI). In this retrospective cohort study they looked at 2’258’711 patients (now that’s a number) in 1431 hospitals who underwent PCI in a period of almost 4 years. Despite a considerable variation on blood transfusions practices among these US hospitals, the receipt of transfusion was associated with increased risk of in-hospital cardiac events (myocardial infarction, stroke and hospital death).
… another puzzle piece towards restriction?
A short educational overview can be found here: http://lifeinthefastlane.com/education/ccc/blood-transfusion-in-icu/
Clinical Practice Guidelines from the AABB 2012: Ann Inten Med. 2012;157:49-58
Clinical Practice Guidelines 2009: Red blood cell transfusion in adult trauma and critical care, Crit Care Med 2009