Indications for blood transfusions in critical illness
1University Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb
DOI: 10.22514/SV101.062015.9 Vol.10,Issue S1,June 2015 pp.35-40
Published: 22 June 2015
Transfusion of blood products should improve tissue oxygenation and reduce negative consequences of anaemia. At the same time, adverse effects of transfusion, such as infections, immunologic reactions and mistransfusion, could be deleterious. Most transfusion guidelines suggest look-ing at the combination of haemoglobin or haematocrit levels in addition to clinical signs in the decision making process for a blood transfusion. The problem with such indications is that the clinical evaluation may be misleading in severely ill patients and haemoglobin levels that impair oxy-gen delivery cannot be determined easily. Many studies attempted to establish more convenient parameters, such as oxygen saturation from mixed and central ve-nous blood, tissue oxygen extraction and other methods. Although the results from these studies are conflicting, it appears that global oxygenation parameters are a good indicator for a blood transfusion in some categories of critically ill patients.
haemoglobin concentration, global oxygenation parameters, transfusion, critical illness
ROBERT BARONICA,DINKO TONKOVIĆ,BOJANA ĐUROVIĆ MRŽLJAK,LOREDANA ĐURIĆ,TIHOMIR KUŠIĆ,KAROLINA REŽEK. Indications for blood transfusions in critical illness . Signa Vitae. 2015. 10(S1);35-40.
1. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology 2015;122(2):241-275.
2. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al.. The CRIT Study: Anemia and blood transfusion in the critically ill--current clinical practice in the United States. Crit Care Med 2004;32(1):39-52.
3. Van Der Linden P. Transfusion strategy. Eur J Anaesthesiol 2001;18(8):495-498.
4. Marcucci C, Madjdpour C, Spahn DR. Physiology, Benefits and Risks of Red Blood Cell Transfusion. In:Vincent JL, editor. Year-book of Intensive Care and Emergency Medicine Volume 2005, 1st ed. Verlag Berlin Heidelberg New York: Springer; 2005.p. 505-516.
5. Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion 2002;42(7):812-818.
6. Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, Song HK, Clough ER; Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Shore-Lesserson LJ, Goodnough LT, Mazer CD, Shander A, Stafford-Smith M, Waters J; International Consortium for Evidence Based Perfusion, Baker RA, Dickinson TA, FitzGerald DJ, Likosky DS, Shann KG. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011;91(3):944-982.
7. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA 2002;288(12):1499-1507.
8. Hajjar LA, Auler Junior JO, Santos L, Galas F. Blood tranfusion in critically ill patients: state of the art. Clinics (Sao Paulo) 2007;62(4):507-524.
9. Napolitano LM, Kurek S, Luchette FA, Corwin HL, Barie PS, Tisherman SA,et al. Clinical practice guideline: red blood cell transfu-sion in adult trauma and critical care. Crit Care Med 2009;37(12):3124-3157.
10. McIntyre L, Tinmouth AT, Fergusson DA. Blood component transfusion in critically ill patients. Curr Opin Crit Care 2013;19:326-333.
11. Hébert PC. Transfusion requirements in critical care (TRICC): a multicentre, randomized, controlled clinical study. Transfusion Requirements in Critical Care Investigators and the Canadian Critical care Trials Group. Br J Anaesth 1998;81 Suppl 1:25-33.
12. Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P, Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators. Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study. Anesthesiology 2008;108(1):31-9.
13. Carson JL, Sieber F, Cook DR, Hoover DR, Noveck H, Chaitman BR, et al. Liberal versus restrictive blood transfusion strategy:
3- year survival and cause of death results from the FOCUS randomised controlled trial. Lancet 2015;385(9974):1183-1189.
14. Hanna EB, Alexander KP, Chen AY, Roe MT, Funk M, Saucedo JF. Characteristics and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction undergoing an invasive strategy according to hemoglobin levels. Am J Cardiol 2013;111(8):1099-1103.
15. Skodlar J, Majerić-Kogler V, Štimac D, Šakić K, Perić M, Balen S, et al. Croatian Medical Association and Croatian Society for Qual-ity Improvement in Health Care transfusion guidelines, 2014.
16. Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC,et al. Management of severe periop-erative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2013;30(6):270-382.
17. Vallet B, Robin E, Lebuf G. Venous oxygen saturation as a physiologic transfusion trigger. Criti Care 2010;14(2):213.
18. Trouwborst A, Tenbrinck R, van Woerkens EC. Blood gas analysis of mixed venous blood during normoxic acute isovolemic hemodilution in pigs. Anesth Analg 1990;70:523-529.
19. Räsänen J. Supply-dependent oxygen consumption and mixed venous oxyhemoglobin saturation during isovolemic hemodilution in pigs. Chest 1992;101(4):1121-1124.
20. Paone G, Silverman NA. The paradox of on-bypass transfusion thresholds in blood conservation. Circulation 1997;96(9 Sup-pl):205–208.
21. Adamczyk S, Robin E, Barreau O, Fleyfel M, Tavernier B, Lebuffe G, Vallet B. Contribution of central venous oxygen saturation in postoperative blood transfusion decision. Ann Fr Anesth Reanim 2009;28(6):522-530.
22. Wilkerson DK, Rosen AL, Gould SA, Sehgal LR, Sehgal HL, Moss GS. Oxygen extraction ratio: a valid indicator of myocardial metabolism in anemia. J Surg Res 1987;42(6):629-634.
23. Levy PS, Chavez RP, Crystal GJ, Kim SJ, Eckel PK, Sehgal LR, et al. Oxygen extraction ratio: a valid indicator of transfusion need in limited coronary vascular reserve? J Trauma 1992;32(6):769-774.
24. Orlov D, O’Farrell R, McCluskey SA, Carroll J, Poonawala H, Hozhabri S, et al. The clinical utility of an index of global oxygenation for guiding red blood cell transfusion in cardiac surgery. Transfusion 2009;49(4):682-688.
25. Sehgal LR, Zebala LP, Takagi I, Curran RD, Votapka TV, Caprini JA. Evaluation of oxygen extraction ratio as a physiologic transfu-sion trigger in coronary artery bypass graft surgery patients. Transfusion 2001;41(5):591-595.
26. O’Farrell R, Ghannam M, McCluskey M, Beattie S, Karkouti K. Oxygen extraction ratio (OER) and blood transfusion in cardiac surgery. Can J Anaesth June 2006;53(1) Suppl:26342
27. Treacher DF, Leach RM. Oxygen transport-1. Basic principles. BMJ 1998;317(7168):1302-1306.
28. Shepherd SJ, Pearse RM. Role of central and mixed venous oxygen saturation measurement in perioperative care. Anesthesiology 2009;111(3):649-656.
29. Turnaoğlu S, Tuğrul M, Camci E, Cakar N, Akinci O, Ergin P. Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation. J Cardiothorac Vasc Anesth 2001;15(5):574-579.
30. Scheinman MM, Brown MA, Rapaport E. Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients. Circulation 1969;40(2):165–172.
31. Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM. Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest 1989;95(6):1216-1221.
32. Žaja J. Venous oximetry. Signa Vitae 2007;2(1):6-10.
33. Marino PL. The ICU Book. Fourth ed. Philadelphia: Lippincott Williams & Wilkins; 2014.
34. Reinhart K, Bloos F. The value of venous oximetry. Curr Opin Crit Care 2005;11(3):259-263.
35. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al; Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580-637.
36. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368–1377.
37. Reinhart K, Kuhn HJ, Hartog C, Bredle DL.Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 2004;30(8):1572-1578.
38. Sekkat H, Sohawon S, Noordally SO. A comparison of mixed and central venous oxygen saturation in patients during and after cardiac surgery. JICS 2009;10(2):99-101.
39. Dueck MH, Klimek M, Appenrodt S, Weigand C, Boerner U. Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology 2005;103(2):249-257.
40. Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M. Lack of equivalence between central and mixed venous oxygen saturation. Chest 2004;126(6):1891-1896.
41. Ho KM, Harding R, Chamberlain J, Bulsara M. A comparison of central and mixed venous oxygen saturation in circulatory failure. J Cardiothorac Vasc Anesth 2010;24(3):434-439.
42. Lorentzen AG, Lindskov C, Sloth E, Jakobsen CJ. Central venous oxygen saturation cannot replace mixed venous saturation in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2008;22(6):853-857.
43. Elsherbeny A, Belahith M. Agreement between central and mixed venous oxygen saturation following cardiac surgery. J Anesth Clin Res 2014;5:2.
44. Bashir Z, Haynes S, Sandbach P, Calderwood R, McCollum C, Thorniley M. Cerebral oxygen saturation measurements in red cell transfusion. Adv Exp Med Biol 2012;737:51-56.
45. Mung’ayi V, Sharif T, Odaba DS. Blood transfusion and oxygen extraction ratio in patients admitted to the general intensive care unit: A quasi experimental study. Afr J Emerg Med 2014;4(2):66–70.
46. Stowell CP. All politics, and oxygenation, are local: decision making and red blood cell transfusion. Transfusion 2009;4(49):620-621.
47. Tsai AG, Cabrales P, Intaglietta M. Microvascular perfusion upon exchange transfusion with stored red blood cells in normov-olemic anemic conditions. Transfusion 2004;44(11):1626-1634.
48. Leung JM, Weiskopf RB, Feiner J, Hopf HW, Kelley S, Viele M et al. Electrocardiographic ST-segment changes during acute, severe isovolemic hemodilution in humans. Anesthesiology 2000;93:1004-1010.
49. Creteur J, Neves AP, Vincent JL. Near-infrared spectroscopy technique to evaluate the effects of red blood cell transfusion on tissue oxygenation. Crit Care 2009;13 (Suppl 5):S11.
50. Vretzakis G, Georgopoulou S, Stamoulis K, Tassoudis V, Mikroulis D, Giannoukas A, et al. Monitoring of brain oxygen saturation (INVOS) in a protocol to direct blood transfusions during cardiac surgery: a prospective randomized clinical trial. J Cardiothorac Surg 2013;8:145.
Science Citation Index Expanded (SciSearch) The Science Citation Index (SCI) is a citation index originally produced by the Institute for Scientific Information (ISI) and created by Eugene Garfield. It (Science Citation Index Expanded) covers more than 8,500 notable and significant journals, across 150 disciplines in science and technology, from 1900 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.