Transfusion management in critically ill patients

Blood component transfusion remains a common intervention in critically ill patients and is primarily used to support oxygen delivery and correct coagulopathy. Over the past two decades, evidence from randomized trials and systematic reviews have supported the adoption of restrictive transfusion strategies in most critically ill populations. However, transfusion decisions should be individualized in patients with conditions involving ischemia-sensitive organs, including acute myocardial infarction and acute neurologic injury, where higher thresholds may be appropriate. Management of bleeding and coagulopathy in critical illness also involves platelet transfusion, coagulation factor replacement, and antifibrinolytic therapy. Increasingly, viscoelastic assays are used to guide targeted hemostatic therapy. Although transfusion can be lifesaving, it carries potential risks including transfusion reactions, circulatory overload, and transfusion-related lung injury. Optimal transfusion practice therefore requires balancing physiologic need with transfusion-related risks while applying evidence-based thresholds within the clinical context of critical illness.