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CE Article

Packed Red Blood Cell Transfusion in the Intensive Care Unit: Limitations and Consequences

Corresponding author: Division of Cardiovascular Disease and Critical Care Medicine, Cooper University Hospital, Dorrance D 430, Camden, NJ 08103 (e-mail: gerber-dave{at}cooperhealth.edu).

• Objective To review the literature on the limitations and consequences of packed red blood cell transfusions, with particular attention to critically ill patients.

• Methods The PubMed database of the National Library of Medicine was searched to find published articles on the indications, clinical utility, limitations, and consequences of red blood cell transfusion, especially in critically ill patients.

• Results Several dozen papers were reviewed, including case series, meta-analyses, and retrospective and prospective studies evaluating the physiological effects, clinical efficacy, and consequences and complications of transfusion of packed red blood cells. Most available data indicate that packed red blood cells have a very limited ability to augment oxygen delivery to tissues. In addition, the overwhelming preponderance of data accumulated in the past decade indicate that patients receiving such transfusions have significantly poorer outcomes than do patients not receiving such transfusions, as measured by a variety of parameters including, but not limited to, death and infection.

• Conclusions According to the available data, transfusion of packed red blood cells should be reserved only for situations in which clear physiological indicators for transfusion are present.

Notice to CE enrollees: A closed-book, multiple-choice examination following this article tests your understanding of the following objectives: Examine data regarding critical care patients and packed red blood cell transfusion. Identify circumstances in which transfusions are necessary. Discuss the consequences of routine packed red blood cell transfusions in critically ill patients. To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue."

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				N. K. Singh, D. R. Gerber, S. Gould, and M. J. Cimino Beware of Transfusion-Related Confounders in Studies on Packed Red Blood Cells Am. J. Crit. Care., May 1, 2007; 16(3): 206 - 206. [Full Text] [PDF]