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Red blood cell transfusion in non-bleeding critically ill patients with moderate anemia: is there a benefit?

Santiago R. Leal-Noval| Manuel Muñoz-Gómez| Mercedes Jiménez-Sánchez| Aurelio Cayuela| María Leal-Romero| Antonio Puppo-Moreno| Judy Enamorado| Victoria Arellano-Orden
Original
Volume 39, Issue 3 / March , 2013

Pages 445 - 453

Abstract

Purpose

This study was undertaken to investigate the efficacy of red blood cell transfusion (RBCT) at reversing the deleterious effects of moderate anemia in critically ill, non-bleeding patients.

Methods

This was a retrospective, pair-matched (ratio 1:1) cohort study. Non-bleeding critically ill patients with moderate anemia (nadir hemoglobin level between 70 and 95 g/l), admitted to the ICU over a 27-month period, were included. Anemic patients were included upon meeting five matching criteria of having the same nadir hemoglobin (±5 g/l), APACHE II score (±5), SOFA score (±2), admission diagnostic group, and age (±5 years). Outcome events occurring over the whole ICU stay and after RBCT were collected. After hospital discharge, all patients had a 2-year follow-up period.

Results

Two hundred fourteen non-transfused anemic patients (NTAPs) were successfully matched with 214 transfused anemic patients (TAPs). In addition to the matching criteria, at baseline, both groups were homogenous with respect to multiple comorbidities. Compared with TAPs, NTAPs showed significantly lower rates of hospital mortality (21 vs.13 %, respectively; p < 0.05) and ICU re-admission (7.4 vs. 1.9 %, respectively; p < 0.05). Additionally, NTAPs had significantly lower rates of nosocomial infection (12.9 vs. 6.7 %, respectively; p < 0.05) and acute kidney injury (24.8 vs. 16.7 %, respectively; p < 0.05). Similar results were obtained in subgroup analysis where only more anemic patients (68 matched pairs) or patients with cardiovascular comorbidities (63 matched pairs) were considered.

Conclusions

RBCT does not improve the clinical outcome in non-bleeding critically ill patients with moderate anemia.

Keywords

References

  1. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellman A, Nollet G, Peres-Bota D, ABC Investigators (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507
    • View reference on PubMed
    • View reference on publisher's website
  2. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabott MM, Duh MS, Shapiro MJ (2004) The CRIT study: Anemia and blood transfusion in the critically ill—current clinical practices in the United States. Crit Care Med 32:39–52
    • View reference on PubMed
    • View reference on publisher's website
  3. Napolitano LM, Kurek S, Luchette FA, Corwin HL, Barie PS, Tisherman SA, Hebert PC, Anderson GL, Bard MR, Bromberg W, Chiu WC, Cipolle MD, Clancy KD, Diebel L, Hoff WS, Hughes KM, Munshi I, Nayduch D, Sandhu R, Yelon JA, American College of Critical Care Medicine of the Society of Critical Care Medicine, Eastern Association for the Surgery of Trauma Practice Management Workgroup, American College of Critical Care Medicine of the Society of Critical Care Medicine, Eastern Association for the Surgery of Trauma Practice Management Workgroup (2009) Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Crit Care Med 37:3124–3157
    • View reference on PubMed
    • View reference on publisher's website
  4. Wang JK, Klein HG (2010) Red blood cell transfusion in the treatment and management of anaemia: the search for the elusive transfusion trigger. Vox Sang 98:2–10
    • View reference on PubMed
    • View reference on publisher's website
  5. Weiskopf RB, FeinerJ Hopf H, Lieberman J, Finlay HE, Quah C, Kramer JH, Bostrom A, Toy P (2006) Fresh blood and aged stored blood are equally efficacious in immediately reversing anemia-induced brain oxygenation deficits in humans. Anesthesiology 104:911–920
    • View reference on PubMed
    • View reference on publisher's website
  6. Kramer AH, Zygun DA (2009) Anemia and red blood cell transfusion in neurocritical care. Crit Care 13:R89
    • View reference on PubMed
    • View reference on publisher's website
  7. Gerber DR (2008) Transfusion of packed red blood cells in patients with ischemic heart disease. Crit Care Med 36:1068–1074
    • View reference on PubMed
    • View reference on publisher's website
  8. 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. Society of Thoracic Surgeons Blood Conservation Guideline Task Force; Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion. International Consortium for Evidence Based Perfusion. Ann Thorac Surg 91:944–982
    • View reference on PubMed
    • View reference on publisher's website
  9. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med 34:17–60
  10. Ranucci M, Conti D, Castelvecchio S, Menicanti L, Frigiola A, Ballotta A, Pelissero G (2010) Hematocrit on cardiopulmonary bypass and outcome after coronary surgery in nontransfused patients. Ann Thorac Surg 9:11–17
    • View reference on publisher's website
  11. Carson JL, Noveck H, Berlin JA, Gould SA (2002) Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion 42:812–818
    • View reference on PubMed
    • View reference on publisher's website
  12. Shehata N, Burns LA, Nathan H, Hebert P, Hare GM, Fergusson D, Mazer CD (2012) A randomized controlled pilot study on adherence to transfusion strategies in cardiac surgery. Transfusion 52:91–99
    • View reference on PubMed
    • View reference on publisher's website
  13. Gombotz H, Rehak PH, Shander A, Hofmann A (2007) Blood use in elective surgery: the Austrian benchmark study. Transfusion 47:1468–1480
    • View reference on PubMed
    • View reference on publisher's website
  14. Leal-Noval SR, Arellano-Orden V, Maestre-Romero A, Múñoz-Gómez M, Fernández-Cisneros V, Ferrándiz-Millón C, Corcia Y (2011) Impact of national transfusion indicators on appropriate blood usage in critically ill patients. Transfusion 51:1957–1965
    • View reference on PubMed
    • View reference on publisher's website
  15. Sena MJ, Rivers RM, Muizelaar JP, Battistella FD, Utter GH (2009) Transfusion practices for acute traumatic brain injury: a survey of physicians at US trauma centers. Intensive Care Med 35:480–488
  16. Leal-Noval SR, Rincón-Ferrari MD, García-Curiel A, Herruzo-Avilés A, Camacho-Laraña P, Garnacho-Montero J, Amaya-Villar R (2001) Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest 119:1461–1468
    • View reference on PubMed
    • View reference on publisher's website
  17. Marik PE, Corwin HL (2008) Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 36:2667–2674
    • View reference on PubMed
    • View reference on publisher's website
  18. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative [ADQI] Group. Crit Care 8:R204–R212
    • View reference on PubMed
    • View reference on publisher's website
  19. Elashoff JD. nQuery Advisor Version 4.0 User’s Guide 2008. Los Angeles, CA: Statistical Solutions Ltd
  20. Istaphanous GK, Wheeler DS, Lisco SJ, Shander A (2011) Red blood cell transfusion in critically ill children: a narrative review. Pediatr Crit Care Med 12:174–183
    • View reference on PubMed
    • View reference on publisher's website
  21. Shander A, Fink A, Javidroozi M, Jochen E, Farmer SL, Corwin H, Goodnough LT, Hofmann A, Isbister J, Ozawa S, Spahn, for the International Consensus Conference on Transfusion Outcomes Group (2011) Appropriateness of allogeneic red blood cell transfusion: the international consensus conference of transfusion outcome. Transf Med Rev 25:232–246
    • View reference on publisher's website
  22. Hébert PC, Yetisir E, Martin C, Blajchman MA, Wells G, Marshall J, Tweeddale M, Pagliarello G, Schweitzer I (2001) Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 29:227–234
    • View reference on PubMed
    • View reference on publisher's website
  23. Carson J, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, Nemo G, Dragert K, Beaupre L, Hildebrand K, Macaulay W, Lewis C, Cook DR, Dobbin G, Zakriya KJ, Apple FS, Horney RA, Magaziner J, FOCUS Investigators (2011) Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 365:2453–2462
    • View reference on PubMed
    • View reference on publisher's website
  24. Möhnle P, Snyder-Ramos SA, Miao Y, Kulier A, Böttiger BW, Levin J, Mangano DT, Multicenter Study of Perioperative Ischemia (McSPI) Research Group (2011) Multicenter study of perioperative ischemia (McSPI) research group. Intensive Care Med 37:97–109
  25. Madjdpour C, Spahn D, Weiskopf RB (2006) Anemia and perioperative red blood cell transfusion: a matter of tolerance. Crit Care Med 34(5 Suppl):S102–S108
    • View reference on PubMed
    • View reference on publisher's website
  26. Leal-Noval SR, Muñoz-Gómez M, Arellano-Orden V, Marín-Caballos A, Amaya-Villar R, Marín A, Puppo-Moreno A, Ferrándiz-Millón C, Flores-Cordero JM, Murillo-Cabezas F (2008) Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury. Crit Care Med 36:1290–1296
    • View reference on PubMed
    • View reference on publisher's website
  27. Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P, Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators (2008) Are blood transfusions associated with greater mortality rates? Results of the sepsis occurrence in acutely ill patients study. Anesthesiology 108:31–39
    • View reference on PubMed
    • View reference on publisher's website
  28. Ba VN, Peres-Bota D, Mélot C, Vincent J-L (2003) Time course of hemoglobin concentrations in nonbleeding intensive care unit patients. Crit Care Med 31:406–410
    • View reference on publisher's website
  29. Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized, controlled clinical trial on transfusion requirement in critical care. Transfusion requirements in critical care investigators. Canadian critical care trials group. N Engl J Med 340:409–417
    • View reference on PubMed
    • View reference on publisher's website

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