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Transfusion profiles in intensive care units from a university hospital

Introduction

Red blood cell (RBC) transfusion is very often performed in critically ill patients despite its potential complications. New guidelines recommend that doctors should have conservative behavior regarding its use. The objective of this study was to evaluate the transfusion profile among patients in ICUs at a university hospital in Brazil.

Methods

A prospective evaluation of all patients admitted to six ICUs (surgical–medical, private, neurosurgery, medical, pneumology and coronary units) that have received a RBC transfusion as indicated by assistant physicians during October/November 2005. Clinical data as well as the characteristics of the transfusion were collected and submitted to univariate statistical analysis (chi-squared and Student's t test). Results were considered significant if P ≤ 0.05.

Results

Four hundred and eight transfusions were made in 71 patients (38 females, 33 males), 35 medical/36 surgical, with a mean age 57.2 ± 8.4 years, mean APACHE II score 17.7 ± 5.3, and mean SOFA score on the day of transfusion 6.09 ± 3.99. At admission, 60 patients (84.5%) had comorbidities, 10 (14.1%) had chronic coronary disease. At transfusion, 54.9% had sepsis, severe sepsis or septic shock, and 9.9% had acute coronary syndrome. The mean hemoglobin (Hb) level at ICU admission was 9.69 ± 2.3 g/dl and the mean level that triggered transfusion was 6.88 ± 1.1 g/dl. The most important transfusion indication was Hb levels (49.8%), followed by active bleeding (31.8%). The mean number of RBC transfused per time was 1.68 ± 0.96 and the mean age of RBC was 14.3 ± 7.83 days (46.6% had more than 14 days). Adverse events occurred in 3.4%. The 28-day mortality rate was 47.1%. Only the SOFA score at the day of transfusion correlated with mortality (P = 0.004). There was no correlation with age, type of ICU, APACHE II score, total number or age of RBC, Hb at admission or Hb pretransfusion. There was a significant difference between the pretransfusion Hb (P < 0.00001) and the number of RBC transfused at the same time considering all ICU enrolled in the study (P < 0.00001).

Conclusion

The Hb level that triggered transfusion was in agreement with recent guidelines regarding critically ill patients, although there was a difference between all ICUs. Despite the fact that there is a scarceness of RBC, the RBC were higher in age. The missing correlation with mortality can be due to the small sample size.

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Assuncao, M., Paula, I., Falcao, L. et al. Transfusion profiles in intensive care units from a university hospital. Crit Care 11, P412 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5572

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Keywords

  • Septic Shock
  • Acute Coronary Syndrome
  • Severe Sepsis
  • Active Bleeding
  • Recent Guideline