Transfusing Packed RBCs in Critical Illness

Despite the publication of several guidelines that recommend restrictive over liberal strategies for RBC transfusion, questions persist regarding which patients should receive transfusions and the target hemoglobin levels. Although transfusions can be lifesaving, they also carry the risk of complications that can worsen outcomes in critically ill patients. Evidence from several randomized studies has shown that minimizing transfusions in hemodynamically stable patients can be safe and does not adversely impact important clinical outcomes. One important exception is patients who are experiencing acute coronary syndrome, who may benefit from a liberal transfusion strategy. The decision to transfuse, however, should rely not only on a numeric hemoglobin value but also must consider the overall clinical status of the patient. This article presents 3 patient scenarios to illustrate the management of anemia in hemodynamically stable critically ill patients. It also discusses implementation strategies for patient blood management to optimize transfusion practices and improve patient outcomes.