Anemia in critical care: optimizing transfusion strategies for better outcomes

Abstract

This study critically assesses RBC transfusion strategies in ICU patients with anemia through a PubMed literature review, focusing on recent clinical studies. Key aspects analyzed include study design, methods, results, and implications for critical care. Approximately 30–50% of ICU patients receive RBC transfusions, with anemia being the primary indication in 75% of cases. Evidence supports a restrictive transfusion strategy (hemoglobin < 7 g/dL) over a more liberal approach (<10 g/dL). Restrictive thresholds are recommended for sepsis and gastrointestinal bleeding (<7 g/dL), cardiac surgery (<7.5 g/dL), and stable cardiovascular disease (<8 g/dL). While restrictive strategies are generally supported for hematologic malignancies, acute neurologic injury, and burns, further studies are needed, particularly in acute coronary syndrome. Massive transfusion remains critical for hemorrhagic shock, though the ideal RBC-to-plasma ratio is uncertain. Emerging non-transfusion strategies aim to prevent and manage anemia, alongside renewed interest in whole blood transfusion. The literature predominantly supports restrictive transfusion strategies across critically ill populations. Further research and the integration of novel ICU practices will refine transfusion protocols and improve patient outcomes.