CMAJ • January 1, 2008; 178 (1). doi:10.1503/cmaj.071298.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Review

Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients

Alan T. Tinmouth, MD MSc, Lauralynn A. McIntyre, MD MSc and Robert A. Fowler, MDCM MS

From the University of Ottawa Centre for Transfusion Research (Tinmouth, McIntyre), Ottawa Health Research Institute, Ottawa, Ont.; the Departments of Medicine (Tinmouth) and Critical Care (McIntyre), Ottawa Hospital, Ottawa, Ont.; and the Department of Medicine, Sunnybrook Health Sciences Centre, and the Interdepartmental Division of Critical Care, University of Toronto (Fowler), Toronto, Ont.

Correspondence to: Dr. Alan T. Tinmouth, Ottawa Hospital, 501 Smyth Rd., Box 201, Ottawa ON K1H 8L6; fax 613 739-6266; atinmouth{at}ohri.ca

Abstract

Anemia commonly affects critically ill patients. The causes are multifactorial and include acute blood loss, blood loss from diagnostic testing and blunted red blood cell production. Blood transfusions are frequently given to patients in intensive care units to treat low hemoglobin levels due to either acute blood loss or subacute anemia associated with critical illness. Although blood transfusion is a life-saving therapy, evidence suggests that it may be associated with an increased risk of morbidity and mortality. A number of blood conservation strategies exist that may mitigate anemia in hospital patients and limit the need for transfusion. These strategies include the use of hemostatic agents, hemoglobin substitutes and blood salvage techniques, the reduction of blood loss associated with diagnostic testing, the use of erythropoietin and the use of restrictive blood transfusion triggers. Strategies to reduce blood loss associated with diagnostic testing and the use of hemostatic agents and erythropoietin result in higher hemoglobin levels, but they have not been shown to reduce the need for blood transfusions or to improve clinical outcomes. Lowering the hemoglobin threshold at which blood is transfused will reduce the need for transfusions and is not associated with increased morbidity or mortality among most critically ill patients without active cardiac disease. Further research is needed to determine the potential roles for other blood conservation strategies.


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Can. Med. Assoc. J. 2008 178: 5. [Full Text] [PDF]

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Can. Med. Assoc. J. 2008 178: 5. [Full Text] [PDF]



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May efficacy and safety of erythropoietin be improved by IV iron in ICU patients?.
Manuel Muņoz
CMAJ, 8 Feb 2008 [Full text]