[Treatment with blood products in the intensive care unit]

The evidence for the administration of blood products in the critically ill is frequently meagre. It is often difficult to differentiate between adaptive changes and pathological alterations of blood components requiring treatment. Anemia is frequently observed in critically ill patients; however, there is no evidence for a benefit of a liberal transfusion strategy. Thrombocytopenia and alterations in plasmatic coagulation could correlate with an unfavorable outcome but they are not predictive regarding a substitution. Therefore, the indications for platelet transfusion and the administration of plasma or coagulation factor concentrates should always be clinically and critically evaluated. There is also no evidence for the generous use of albumin in intensive care medicine. In conclusion, a restrictive strategy is recommended for all blood products. The available evidence and a critical clinical assessment should be the mainstays of the decision for treatment with blood products.