More than 30% of patients in intensive care units are anemic. Despite growing evidence to the contrary, most patients are still treated with allogeneic blood transfusions (ABT). A study of transfusion requirements in critically ill patients demonstrated that maintaining a hemoglobin above 7g/dl was as effective as a liberal transfusion strategy. We compared morbidity outcomes of critically ill patients managed with and without ABT in a mixed medical surgical intensive care unit (ICU) setting.
With IRB approval a retrospective chart review of consecutive patients admitted to the ICU with a diagnosis of anemia or who develop severe anemia within 48 hours of admission to the ICU was performed. Patients were divided into 2 groups: those who refused ABT (NABT) for religious reasons and those transfused. Morbidity outcomes included ICU length of stay, cardiac ischemia defined by an elevated Troponin T, renal dysfunction defined as a creatinine increase of 0.5mg/dl from baseline, and blood borne infection defined by positive blood cultures.
The nadir Hb was 5.07 ± 1.5 in the NABT group compared to 6.48 ± 0.99 in the ABT group, P = 0.000. The mean ICU length of stay was 6.2days ± 6.97 in the NABT and 4.83 days ± 4.51 in the ABT group P = 0.101. The incidence of cardiac ischemia was 2% in the NABT group vs 10.7% in those transfused, P = 0.012. The incidence of renal dysfunction was 8% in the NABT group vs 10.7% in the ABT group, P = 0.512. Blood borne infections were 6% in the NABT group and 8.7% in the ABT group, P = 0.456.
There was no difference in the ICU length of stay, incidence of blood borne infections, and renal dysfunction between patients managed without ABT and those transfused. The incidence of cardiac ischemia was significantly higher in the transfused group.
Severely anemic critically ill patients can be managed without ABT with no change in ICU length of stay or other morbidity.
A. Shander, None.