Treatment of Anemia, Blood Transfusion and Its Substitutes in Intensive Care Uniteʾs (ICU) Patients: A Review Based on Current Evidence

Anemia in critically ill patients is common and affects their outcome. Treatment of anemia in ICUʾs patients have some challenges. Red blood cells transfusion is associated with some serious adverse effects which further affects patient’s outcome. In this article, the etiology of the anemia in critically ill and its management strategies is reviewed.

This study was done to summarize findings from earlier evidence on the prevalence and effect of anemia in critically ill patients on their outcome. We searched in medical data sources of PubMed, Scopus and Google Scholar using the following keywords: anemia OR erythropoietin, OR red blood cell, OR transfusion, AND critical illness, OR intensive care. After reviewing title and abstracts, all clinical studies conducted on this group of patients were included.

In most studies, the evidence supports restrictive protocol of RBC transfusion (transfusion at Hb < 7 g/dL) preferably over a liberal transfusion strategy (transfusion at Hb < 10 g/dL), in ICU patients. Only those with acute cardiovascular disease or early stages of severe sepsis may benefit from higher threshold of 9-10g/dL for blood preparation transfusion.

The occurrence of anemia is common in critically ill patients. Considering its multifactorial etiology, it has a negative effect on patients’ outcome. Blood transfusions are associated with some serious adverse effects, such as Acute respiratory distress syndrome and infections. The potential risk benefit must be carefully evaluated in every patient for whom a blood transfusion is being considered.