Blood transfusion practice in critically ill patients: a single institutional experience

To assess the transfusion practice in the intensive care unit (ICU) in a general hospital in Kuwait relative to indications, pretransfusion hemoglobin, red blood cell (RBC) use and outcome.

475 patients were admitted to the ICU during the study period (January 2009 to February 2010). Ninety-nine received RBC transfusion. Demographic, clinical and transfusion data were prospectively collected for the 99 patients who were followed up for 30 days, until hospital discharge, or death, whichever occurred first. Indications for RBC transfusion included hemorrhage in 39 patients, improving oxygen-carrying capacity in 55, and hemolysis in 5.

Of the 99 transfused patients, 22 (22.22%) were also transfused after discharge from the ICU. Transfusions were more frequent in patients admitted with respiratory failure (30, 30.3%), hemorrhagic shock (24, 24.2%), and septic shock (18, 18.4%). The mean pretransfusion hemoglobin in ICU transfusions was statistically different (70.9 ± 12.7 g/l) from transfusions after discharge (79.7 ± 9.4 g/l) (p < 0.001). Longer ICU stay was associated with more RBC units transfused per transfusion episode per patient (p < 0.001). The Sequential Organ Failure Assessment (SOFA) score was significantly associated with the number of RBC units transfused per patient (p = 0.006). Mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and SOFA scores, the need and duration for mechanical ventilation, and the length of stay in hospital.

Intensivists in our center followed a restrictive transfusion practice, by adopting a low pretransfusion hemoglobin threshold. Decisions on RBC transfusions seemed in most cases to be based on a 'transfusion trigger' rather than a physiologic need.