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Hemostatic Changes Following Red Blood Cell Transfusion in Critically Ill Patients: A Retrospective Cohort Study
1Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
Journal of Clinical Medicine
|November 27, 2025
Summary
Red blood cell (RBC) transfusions may weaken clot structure and reduce clot breakdown in critically ill patients. Conventional coagulation tests often fail to detect these hemostatic changes, underscoring the need for viscoelastic monitoring.
Area of Science:
- Critical Care Medicine
- Hematology
- Transfusion Medicine
Background:
- Red blood cells (RBCs) play an active role in hemostasis, influencing platelet activation, thrombin generation, and clot structure.
- RBC transfusion can alter coagulation dynamics, but these effects are often undetected by conventional coagulation tests.
- Viscoelastic monitoring is crucial for assessing the hemostatic impact of RBC transfusions.
Purpose of the Study:
- To investigate the hemostatic effects of single-unit RBC transfusions in critically ill anemic patients.
- To compare the sensitivity of rotational thromboelastometry (ROTEM) with conventional coagulation tests in detecting transfusion-related hemostatic changes.
Main Methods:
- Retrospective single-center study in an intensive care unit.
- Analysis of ROTEM, conventional coagulation tests, and complete blood count (CBC) data pre- and post-RBC transfusion.
- Assessment of platelet and fibrinogen contributions to clot strength.
Main Results:
- ROTEM analysis indicated reduced fibrinogen contribution to clot strength and decreased hyperfibrinolysis after RBC transfusion.
- Conventional coagulation tests showed minimal changes, with a notable increase in D-dimer levels.
- Thirty-five patients were analyzed, revealing subtle but significant alterations in hemostasis.
Conclusions:
- Single RBC transfusions in non-bleeding, critically ill anemic patients may impair fibrinogen-based clot architecture and reduce hyperfibrinolysis.
- Conventional coagulation tests are insufficient for detecting most hemostatic effects of RBC transfusion.
- Further mechanistic studies are required to fully understand the net hemostatic impact of RBC transfusion.
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