NoBlood

Vox Sanguinis
Volume 84 Issue 3 Page 211 - April 2003

ORIGINAL PAPER

Red cell transfusion practice following the transfusion requirements in critical care(TRICC) study: prospective observational cohort study in a large UK intensive care unit
S. S. Chohan1, F. McArdle1, D. B. L. McClelland2, S. J. Mackenzie1 & T. S. Walsh1

Background and Objectives: The Transfusion Requirements In Critical Care (TRICC) study found that critically ill patients tolerate a restrictive haemoglobin transfusion threshold. We investigated red-cell transfusion practice since publication of the TRICC study in a large Scottish teaching hospital intensive care unit (ICU).

Materials and Methods: We prospectively collected daily data for a 6-month period on haemoglobin concentrations, red-cell transfusions and indications for transfusions, throughout ICU stay for all patients who stayed for longer than 24 h in the ICU.

Results: A total of 176 patients were studied, who utilized 1237 ICU days. Of these 176 patients, 52% received red-cell transfusions. A haemoglobin concentration of 9 g/dl was measured in 55% of patients; this occurred by day 1 and day 2 in 52% and 77% of these cases, respectively. Overall the haemoglobin concentration was 9 g/dl for 45% of all patient days. Total red-cell use was 3·1 units per admission (0·47 units per patient day). Only 18% of transfusion episodes were required as a result of haemorrhage. For 'non-haemorrhage' transfusion episodes, the median pretransfusion haemoglobin concentration was 7·8 g/dl (interquartile range: 7·4-8·4 g/dl), and 64% of transfusion episodes were for 2 units.

Conclusions: Clinicians in our centre were conservative, in keeping with recent transfusion guidelines, but deviated from the TRICC protocol by transfusing at haemoglobin concentrations of between 7 and 9 g/dl, rather than below 7 g/dl, and by prescribing 2 unit transfusions. Significant numbers of red-cell units are still used in the critically ill.

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