Anemia and Blood Transfusions in the Intensive Care Unit: A Review

Abstract

Anemia is common among critically ill patients and can be iatrogenic. Its prevalence is influenced by various factors, such as age, comorbidities, and transfusion practices. Blood transfusion remains a pervasive practice with most critically ill patients receiving blood. The decision to transfuse blood in the ICU should be individualized considering the patient's clinical status and comorbidities. Recent studies have highlighted the safety and effectiveness of a restrictive transfusion strategy that can reduce the risk of transfusion-related complications. However, it is crucial to consider the specific needs of certain patient populations, such as those with cardiovascular diseases. Workup starts with a directed history and examination, followed by tailored investigations to answer specific questions. Massive transfusions, when indicated, requires a multidisciplinary team to be orchestrated by the physician and requires knowledge of the criteria for implementing a Massive Transfusion Protocol (MTP), as well as the logistical aspects of obtaining and transfusing blood products. Thromboelastography (TEG) can be a useful tool for guiding blood transfusions in such cases. Transfusion reactions (TR) are potential complications of blood transfusion with varying presentations and degrees of severity. This article delves into the different types of TR, their clinical manifestations, and the necessary workup and management steps, emphasizing the importance of timely intervention.