Red Blood Cell Transfusion in Sepsis: A Review

Abstract

Sepsis is very common and lethal. Sepsis is the leading cause of death in non-coronary Intensive Care Units, and the tenth leading cause of death overall. Red blood cell transfusion is one of the most commonly used interventions in the ICU to treat severe anemia, which often occurs in sepsis. Several problems were documented with RBC transfusions and will be reviewed, such as infection, pulmonary complications such as TRALI and Transfusion-Associated Circulatory Overload (TACO), Transfusion-Related Immunomodulation (TRIM) and multiorgan failure, and increased mortality. Most of these complications are partially explained by volume of the unit of blood as well as pathogenic factors of stored RBCs related to 2,3 BPG concentration, inflammatory mediators, nitric oxide, ATP concentration and RBC rheology, and RBC adhesion characteristics. These same factors are present in RBCs of septic patients as well. Until better evidence is available, a “restrictive” strategy of RBC transfusion (transfuse when Hb < 7 g/dL) is recommended except in acute hemorrhage, or in patients with acute myocardial ischemia when a hemoglobin trigger of 8 g/dl is reasonable.