Red Blood Cell Transfusion in the Intensive Care Unit
Authors: Raasveld Senta Jorinde , de Bruin Sanne , Reuland Merijn C. , van den Oord Claudia , Schenk Jimmy , Aubron Cécile , Bakker Jan , Cecconi Maurizio , Feldheiser Aarne , Meier Jens , Müller Marcella C. A. , Scheeren Thomas W. L. , McQuilten Zoe , Flint Andrew , Hamid Tarikul , Piagnerelli Michaël , Tomić Mahečić Tina , Benes Jan , Russell Lene , Aguirre-Bermeo Hernan , Triantafyllopoulou Konstantina , Chantziara Vasiliki , Gurjar Mohan , Myatra Sheila Nainan , Pota Vincenzo , Elhadi Muhammed , Gawda Ryszard , Mourisco Mafalda , Lance Marcus , Neskovic Vojislava , Podbregar Matej , Llau Juan V. , Quintana-Diaz Manual , Cronhjort Maria , Pfortmueller Carmen A. , Yapici Nihan , Nielsen Nathan D. , Shah Akshay , de Grooth Harm-Jan , Vlaar Alexander P. J. ,   InPUT Study Group, Higgins Alisa , Serpa Neto Ary , Brady Karina , Wood Erica , Poole Alexis , Trapani Tony , Young Meredith , Cooper Jamie , Secombe Paul , Reece Graham , Marella Prashanti , Brewster David , Rashid Alan , Suwandarathne Ruwan , Azad Raman , Barrett Jonathan , Turner Elisha , Poulter Amber-Louise , Chen Lixian , Biradar Vishwanath , Whitehead Christina , Peake Sandra , Tabah Alexis , O'Connor Stephanie , Reade Michael , Janssen Guido , McAllister Richard , Triplett Katherine , Bowen David , Buscher Hergen , Santamaria John , Parmar Dinesh , Power Paul , French Craig , Mac Partlin Matthew , Islam Md Motiul , Haque Injamam Ull , Roman Alain , Haentjens Lionel , Ikic Višnja , Kvolik Slavica , Bojčić Robert , Juričić Kazimir , Duksa Martin , Bílek Lukáš , Satinsky Igor , Zatloukal Jan , Russell Lene , Bestle Morten H. , Meyhoff Christian S. , Diaz-Medina Ana Maria , Llumiquinga Verónica , Aguirre-Bermeo Hernán , Gonzabay-Campos Heinert Enmanuel , Elbahnasawy Mohamed , Chapalain Xavier , Le Moal Charlène , Egreteau Pierre-Yves , Launey Yoann , Reizine Florian , Boissier Florence , Jean Reignier , Ehrmann Stephan , Lebas Eddy , Corno Gaelle , Cailliez Pauline , Garçon Pierre , Carteaux Guillaume , Kimmoun Antoine , Theodoulou Danai , ALOIZOS STAVROS , Papadakis Eleftherios , TSAKALIS KONSTANTINOS , Marinakis Giorgos , Georgakas Ioannis , Tripolitsioti Paraskevi , Nikolakopoulou Sofia , Papathanakos Georgios , Sklavou Chrysanthi , Tsika Evangelia , Mousafiri Ourania , Prekates Athanasios , Micha Georgia , Lavrentieva Athina , Aslanidis Theodoros , Palaiologou Athina , Bostantzoglou Clementine , Dikoudi Evangelia , Karaouli Silia , Pouriki Sophia , Vijayakumaran Swapna , Rathod Darshana , KOLA VENKAT RAMAN , Jeswani Deepak , Gopalakrishna Kadarapura Nanjundaiah , Hartalkar Amol , Mahmoodpoor Ata , Abdulkhaleq Marwah , Ippolito Mariachiara , Cotoia Antonella , Covotta Marco , Sanfilippo Filippo , Ishteiwy Ehab , Benzarti Hebtallah , Bouhuwaish Ahmed Elmabri Mohammed , Abdalhadi Alya , Buimsaedah Ahmad , Abdulwahed Eman Ali , Tamoos Khalil , Younes Eman , Alkamkhe Asma Abubakr Saleh , Biala Marwa , Hwili Hajer Abdalla Mohammed , Ben Hasan Najat Shaban , Almiqlash Bushray Alhadi , Altair Mawadda , Otman Rema , Al Gharyani Mohamed Fathi , Alkeelani Omlez Mohammed , Bakeer Hibah , Omar Affat Azah Mukhtar , Aween Husayn , Benamwor Aihab , Alsori Mohamed , Abdelrahim Najwa , Abdelilah GHANNAM , Parke Rachael , Chen Yan , Mehrtens Jan , Twardowski Pawel , Freebairn Ross , Song Rima , Gibson Charles , Chen Jonathan , Moore Richard , Sol Cruz Mary Rose , Wludarczyk Anna , Krzych Łukasz , Szczukocka Marta , Kubiak Marcin , Molsa Maciej , Wujtewicz Magdalena , Wieczorek Agnieszka , Misiewska-Kaczur Agnieszka , Maslicki Marek , Onichimowski Dariusz , Mazur Jakub , Zatorski Pawel , Mota Ana Marta , Fernandes Joana , Castro Diana , Coelho Elisabete , Paula Alexandra , Guimarães Teresa , Adrião Diana , Mark Igor , Mušič Elizabeta , Mirković Tomislav , Markota Andrej , Krope Natalija , Kmet Marko , Forjan Petra , Savli Tomaž , Aguilar Gerardo , González-Celdrán Rebeca , Martínez-González Estefanía , Díaz Agustín , Colomina María José , Hidalgo Francisco , Ferrando Carlos , Ferrandis Raquel , Ferrer Carolina , Cegarra Virginia , Gómez-Luque Aurelio , Henman Stina , Blomstrand Disa , Risberg Emelie , Johansen Natalie , Rajala Henrik , Layous Natalie , Vlot Eline A. , Erkamp Michiel , Juffermans Nicole , van Wonderen Stefan , Kuznecova-Keppel Hesselink Lidija , van Bochove Victor , Acarel Murat , Senturk Evren , Karahan Mahmut Alp , Camkiran Firat Aynur , Yildiz Yahya , Ekinci Osman , Ozgultekin Asu , Arikan Huseyin , Kucukosman Gamze , Aydin Bengu Gulhan , Yavuz Mehmet , Oztas Alev , Kavrut Ozturk Nilgun , Kasapoglu Umut Sabri , Miniksar Hakan , Tuncay Eylem , Indelen Cenk , Ogus Halide , Erdivanli Basar , Sahin Ayca Sultan , Yilmaz Mehmet , Sayan Erken , Yilmaz Canan , Goksu Senay , Basaran Betul , Kutahya Emine , Gok Ayfer Kaya , Ozcan Ayse , Kara Iskender , Kartal Seyfi , Saracoglu Kemal Tolga , Bilir Yeliz , Eyupoglu Selin , Ertugrul Oruc Nigar , Issever Kubilay , Patel Jamie , Clarke Jayson , Ma Louise , Lawton Tom , Sloan Brendan , Kannan Santhana , Innes Richard , Carpenter Mark , Newey Luke , Alwagih Hazem , Acott Chris , Hormis Anil , Herdman James , Akrama Osama , Baumber Rachel , Khomenko Olena , Khan Akram , Hasan Zubair , Raval Jay S. , Sutherland Lauren 
Published: October 2023

Importance

Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice.

Objective

To evaluate and describe ICU RBC transfusion practices worldwide.

Design, Setting, and Participants

International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks.

Exposure

ICU stay.

Main Outcomes and Measures

The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused.

Results

Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL.

Conclusions and Relevance

RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.