Indications for Red Cell Transfusion in the Intensive Care Unit at the University Hospital of the West Indies

Objective: To determine current red cell transfusion practices, transfusion indications and their relationship to patient outcome in intensive care unit (ICU) patients at the University Hospital of the West Indies (UHWI). Method: An observational study was conducted over seven months in the two ICUs at the UHWI, on all patients over 16 years who had been admitted for more than 24 hours. Patient demographics, indication( s) for transfusion, haemoglobin level at the time of transfusion, details of ICU admission and patient outcome were recorded. Data analysis was done using Stata v12. Results: Of the 203 patients included in the study, 79 were transfused (39%). A low haemoglobin level was the most common indication for transfusion, with a mean of 7.3 +/- 1.5 g/dL. Patients who were transfused had higher phlebotomy volumes [61.9 versus 126.1 mL, p < 0.001], were more likely to require mechanical ventilation (p = 0.002) and inotropic support (p = 0.007). Most were surgical patients (p = 0.01) and were post-open heart/thoracic surgery (66% transfusion rate). Patient outcome was correlated with transfusion, as transfused patients had longer ICU stays (13.0 versus 6.7 days, p < 0.001) and increased mortality rates (32.9% compared to 20.2%, p = 0.04). Most transfusions occurred within the first week of admission (83.5%). Conclusion: The mean haemoglobin for transfusion at the ICU, UHWI, is 7.3 g/dL, just above the recommended trigger of 7.0 g/dL in a restrictive transfusion practice. Transfusion policies are needed to better allocate a scarce commodity and minimize complications associated with blood transfusion.