Anemia and Red Blood Cell Transfusion Practices in a Medical Intensive Care Unit

Abstract

Objective: The study was aimed to describe red blood cell (RBC) transfusion practices in a medical intensive care unit (ICU). Material and Method: This retrospective study involved patients admitted to the ICU between September 2015 and February 2020. A restrictive transfusion strategy was applied during the study period, in which hemoglobin levels were kept between 7.0 and 9.0 g/dL, and the recommended threshold for RBC transfusion was <7 g/dL, except for patients with acute coronary disease, acute cerebrovascular event, heart failure, severe hypoxemia, or undergoing hip fracture surgery, for whom hemoglobin levels were kept at ≥8 g/dL. Results: Six hundred seventeen patients were included in the study (age 70±16 years, 51.7% male), with a mean hemoglobin level of 11.1±2.3 g/dL on admission. RBC transfusion was performed on 204 (33.1%) patients, and admission hemoglobin levels were significantly lower in the transfused than the non-transfused patients (9.4±1.9 vs. 11.9±2.1 g/dL; p<0.001). ired high rates of invasive mechanical ventilation, renal replacement therapy and vasopressor use, and had longer ICU and hospital stays. ICU, in-hospital, 28-day, and 90-day mortality rates were significantly high among transfused patients. Logistic regression analysis identified RBC transfusion as an important predictor of 28-day (OR, 2.51; 95% CI, 1.49-4.23, p=0.001) and 90-day (OR, 1.69; 95% CI, 1.25-2.28; p=0.001) mortality. Conclusion: Patients receiving RBC transfusion have high disease severity scores, exhibit low admission hemoglobin levels, require more organ support therapies, and have high mortality rates. The presence of RBC transfusion is a significant predictor of mortality.