The anemic patient in the ICU: How much does the heart tolerate?

Anemia in the critical care setting is a common condition frequently resulting in the use of red cell transfusions. Of particular concern are those anemic, critically ill patients with ischemic heart disease. This critically ill population may be predisposed to the adverse consequences of anemia, by the very nature of their underlying cardiac disease. However, they may also be more predisposed to the adverse consequences of RBC transfusion. Research to date has provided opposing views in terms of the optimal transfusion strategies for use in this "at risk" population. While observational studies have indicated that a liberal strategy is more beneficial, a recent RCT found that a strategy maintaining hemoglobin concentrations between 70 and 90 g/L may result in similar, if not better, outcomes. Further studies are needed, however, to clarify whether the results of this trial can be generalized to patients with cardiovascular disease.