Crit Care Med. 2003 Dec;31(12 Suppl):S715-20.

Blood conservation in the intensive care unit.

Fowler RA, Berenson M.

Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.

OBJECTIVE: To describe blood conservation strategies for critically ill patients. DATA SOURCES: By using a predefined strategy, we searched the electronic databases of Medline, EMBASE, CINAHL, the Cochrane database of systematic reviews, Cochrane central register of controlled trials, ACP Journal Club, Database of abstracts of reviews and effects, and HealthSTAR for descriptions and evaluations of strategies of blood conservation among critically ill patients. DATA SUMMARY: A number of blood conservation strategies have been used to prevent or treat anemia among critically ill patients. These include restrictive diagnostic phlebotomy using small-volume or pediatric phlebotomy tubes, point-of-care and inline bedside microanalysis, minimization of diagnostic sample waste, minimization of routine multiple daily phlebotomies, red blood cell salvage and antifibrinolytic agents for bleeding patients, consideration of removal of central venous and arterial catheters when no longer required for physiologic monitoring, threshold-based transfusion policy, and healthcare professional education. CONCLUSIONS: There are many strategies of blood conservation for critically ill patients. The effects of these strategies on phlebotomy volumes, hemoglobin and hematocrit levels, transfusion requirements, clinical outcomes, as well as intensive care unit and laboratory resources and costs should be further evaluated.