Patient blood management in general intensive care patients

Abstract

Purpose: Critically ill and high-risk perioperative patients requiring intensive care are often multimorbid and depend on rapid, highly specialized management. While most comorbidities are difficult to modify in the acute setting, anemia, particularly iron-defi ciency anemia, represents a potentially modifiable risk factor. Clinicians are also often confronted with complex alterations in hemostasis that require rapid assessment and targeted therapeutic interventions, including the optimal use of blood products. This narrative review summarizes the current evidence on Patient Blood Management strategies, including anemia management, the use of small-volume tubes, and the appropriate use of blood products in intensive care unit patients. Results: Intravenous iron supplementation can safely raise hemoglobin to a clinically meaningful degree. Erythropoietin therapy may also raise hemoglobin, but its use should remain selective given uncertain thromboembolic risk. Small-volume blood collection tubes and closed blood-conservation systems should be routinely used to reduce iatrogenic anemia. Current evidence supports restrictive red blood cell transfusion strategies in most clinical settings, particularly in patients with gastrointestinal bleeding. Similarly, a restrictive platelet transfusion strategy is supported by current evidence. Prophylactic platelet transfusion should be reserved for high-risk hematologic malignancies. In other critically ill patients with severe thrombocytopenia, a therapeutic (bleeding-driven) approach is preferred. Finally, current evidence does not support prophylactic fresh frozen plasma transfusion in non-bleeding patients. Conclusions: Overall, these findings support the implementation of Patient Blood Management strategies that optimize blood health and promote safer, more individualized care in critically ill patients. Visual abstract: (Figure presented.)