Recent literature has suggested that recombinant human erythropoietin alfa (rHuEPO) administered to critically ill patients reduces the number of units of packed red blood cells (PRBCs) transfused in the medical intensive care unit (MICU). We compared the number of units of PRBCs transfused in the MICU before and after the institution of a blood transfusion guideline and subcutaneously administered rHuEPO in critically ill patients in 2003.
This is a retrospective record review for the years before and after the use of rHuEPO and the blood transfusion guideline. This blood-conservation guideline recommends transfusion of PRBCs at specific hematocrit levels. Patients with a hematocrit of less than 38% and an anticipated stay in the MICU of greater than four days were eligible to receive rHuEPO. The transfusion rate and number of units transfused in the MICU at our institution were reviewed for 2002 and 2003.
The transfusion rate was 32.1% in 2002 and 33.2% in 2003 (p=0.71) for all patients admitted. The transfusion rate for patients who stayed five days or more were 52.8% in 2002 and 54.0% in 2003. For all patients, the mean number of units transfused per patient day was 0.36 in 2002 and 0.30 in 2003 (p=0.84). The mean units transfused per patient day for patients with length-of-stay greater than 4 days was 0.29 in 2002 and 0.29 in 2003 (p=0.966).
The institution of a blood transfusion guideline a major teaching institution, along with the concurrent administration of rHuEPO, did not result in a significant reduction in either the transfusion rate or the blood transfused per patient day.
rHuEPO has been shown to reduce the amount of blood transfused in the critical care setting in previous clinical trials that excluded many subpopulations. This study, which considered transfusion in all patients, suggests that there may be no difference in the general ICU population. This study has limitations associated with other retrospective non-randomized studies.
N.T. Ly, None.