Transfusion of red blood cells in the ICU: less is better!

Anemia is a common problem in critically ill patients, sometimes driven by some underlying comorbidities, but most often related to alterations in erythropoiesis and repeated blood loss and draws. Hence patients in the intensive care unit (ICU) are frequently prone to red blood cell (RBC) transfusions. Since the publication in 1999 of the pivotal study TRICC, indications of RBC transfusions have generally been restricted to maintain a haemoglobin level above 7 g.dL(-1). RBC transfusion is likely to be associated with serious adverse side-effects such as increased susceptibility to nosocomial infections and increased mortality rate. Quality improvements in blood products through leucodepletion and shorter durations of storage may contribute to improve the safety of RBC transfusion. The present article aims to review the current indications and potential risks of RBC transfusion in the ICU, excluding haemorrhagic shock.