Use of blood products in the critically ill
- Addison K May, MD
Addison K May, MD
- Professor of Surgery and Anesthesiology
- University of Vanderbilt Medical Center, Nashville
- John P Reilly, MD, MSCE
John P Reilly, MD, MSCE
- Instructor of Medicine
- University of Pennsylvania, Perelman School of Medicine
- Section Editors
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
Transfusion of red blood cells or another blood product is common in the intensive care unit (ICU). It has been estimated that greater than 40 percent of patients receive one or more red blood cell transfusions while in the ICU, of which approximately 90 percent are provided in the context of stable anemia [1-4].
The appropriate use of blood products requires that the potential benefits and risks be carefully weighed for each patient. Indications and complications of blood product transfusion in the ICU are reviewed here, as well as the various types of blood products. Other issues related to transfusion of blood products are discussed separately. (See "Red blood cell transfusion in adults: Storage, specialized modifications, and infusion parameters" and "Clinical use of plasma components" and "Clinical use of Cryoprecipitate" and "Clinical and laboratory aspects of platelet transfusion therapy" and "Initial evaluation and management of shock in adult trauma", section on 'Transfusion of blood products'.)
RED BLOOD CELLS
RBC indications — Indications for the transfusion of packed red blood cells (RBCs) in critically ill patients include the following [5,6]:
●Acute hemorrhage with hemodynamic instability (ie, hemorrhagic shock).
●Acute anemia with inadequate oxygen delivery (eg, cool vasoconstricted skin, obtundation or restlessness, oliguria or anuria, lactic acidosis, an oxygen extraction ratio of greater than 0.3, and/or an oxygen delivery of less than 10 to 12 mL/kg per minute). (See "Oxygen delivery and consumption".)
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- RED BLOOD CELLS
- RBC indications
- RBC preparations
- RBC alternatives
- RBC response
- PLASMA PRODUCTS
- Plasma indications
- Plasma preparations
- Plasma response
- Platelet indications
- - Special considerations
- Platelet preparations
- Platelet response
- Immunologic reactions
- Volume overload
- Citrate toxicity
- Acute lung injury
- Posttransfusion purpura
- SUMMARY AND RECOMMENDATIONS