Transfusion in the intensive care unit: strategies under scrutiny

The transfusion of blood products continues to be an important technique for resuscitating patients in intensive care settings. A number of provocative studies have been published in the past year which examine the transfusion of blood products and alternatives. The Transfusion Requirements in Critical Care (TRICC) trial clearly established the safety of a restrictive transfusion strategy, thereby suggesting that physicians could easily minimize exposure to allogeneic red blood cells by lowering their transfusion threshold. The crystalloids versus colloids debate was also fueled by a number of studies this past year, specifically a meta-analysis which reported a 4% increase in absolute risk of mortality associated with resuscitation therapy using colloids. A recent study demonstrated that erythropoietin is a promising therapy in the intensive care. We can anticipate the results of a trial, currently underway, for further evidence of the use of smaller doses of erythropoietin in the ICU setting.