Day or overnight transfusion in critically ill patients: does it matter?

Area of Science:

• Critical Care Medicine
• Transfusion Medicine
• Epidemiology

Background:

• Blood product administration timing is patient-driven.
• Overnight transfusions in intensive care units (ICUs) are common.
• Understanding the epidemiology and significance of overnight transfusions is crucial.

Purpose of the Study:

• To define the epidemiology of overnight transfusions in critically ill patients.
• To assess the significance and indications of overnight transfusions.
• To compare characteristics of day versus overnight transfusions.

Main Methods:

• Post hoc analysis of a prospective multicentre observational study.
• Included 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP), or cryoprecipitate.
• Compared patients receiving transfusions only during the day (8 am-8 pm) versus overnight (8 pm-8 am), analyzing transfusion characteristics and factors associated with major bleeding.

Main Results:

• Similar patient severity and mortality between day-only and overnight-only transfusion groups.
• Major bleeding was a more frequent indication for transfusion overnight (30%) compared to daytime (12%).
• Overnight transfusion was independently associated with increased odds of major bleeding (OR, 3.16).

Conclusions:

• Blood product administration occurs evenly between day and night in ICUs.
• Differences in blood product types administered reflect varying indications.
• Critically ill patients are more likely to receive transfusions for major bleeding at night.