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Transfusion intensity in the ICU: Reasons and triggers
Merijn C Reuland1, Senta J Raasveld1,2, Jimmy Schenk1,2,3
1Department of Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Transfusion
|August 1, 2026
Summary
Reasons for red blood cell (RBC) transfusions in critically ill patients vary by transfusion intensity. Hypotension and tachycardia are common triggers, but their frequency differs in massive transfusions.
Area of Science:
- Critical Care Medicine
- Transfusion Medicine
- Clinical Physiology
Background:
- Understanding transfusion triggers in critically ill patients is limited.
- Hemodynamic instability is often cited but its role is unclear across contexts.
Purpose of the Study:
- To determine if reasons/triggers for RBC transfusions differ by intensive care unit (ICU) day transfusion intensity.
- To describe reasons for non-RBC transfusions across transfusion intensity groups.
Main Methods:
- Sub-study of the International Point Prevalence Study of Intensive Care Unit Transfusion Practices (InPUT).
- ICU days classified by transfusion intensity: nonmajor (1 RBC unit), major (≥2 units), massive (≥6 units/event, ≥10/day, or MTP activation).
- No bleeding days excluded from analysis.
Main Results:
- Reasons for RBC transfusion composition differed significantly across intensity groups (PERMANOVA).
- Hypotension was a frequent trigger: nonmajor (54%), major (68%), but less in massive (30%).
- Tachycardia was also common: nonmajor (37%), major (40%), massive (22%).
Conclusions:
- RBC transfusions have distinct, intensity-dependent reasons and triggers.
- Transfusion intensity and clinical context are vital for evaluating transfusion practices.
- Hypotension and tachycardia are the most cited physiological triggers in bleeding critically ill patients.
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