Inappropriate use of blood components in critical care?

Due to potential risk of blood transfusions, clinical guidelines emphasize restrictive use of blood components. However, numerous studies indicate that adherence to guidelines is often less than optimal. Furthermore, information regarding use of blood transfusion in intensive care units (ICUs) and compliance to clinical guidelines is lacking. We studied the use of blood components in two adult ICUs in Iceland and the compliance to clinical guidelines. All adult patients that received blood components in both ICUs at Landspitali during 6 months in 2010 were studied. Hematology and coagulation parameters as well as indications for administration were compared with hospital guidelines. 202 patients (34%) received blood components, half of them after surgery. 30% received red-blood cells (RBCs), 18% fresh frozen plasma (FFP) and 9% platelets. The mean hemoglobin value before RBC transfusion was 87 g/L, but in one third of cases it exceeded 100 g/L. FFP was transfused at a normal prothrombin time in 9% of cases. No coagulation parameters were available before transfusion of 5% of FFP. Mean platelet count before transfusion of platelets was 82 x109/L and in 34% of cases it exceeded 100 x109/L. One third of patients received blood components during their ICU stay, most commonly RBCs. At least 6% of RBCs, 14% of FFPs and 33% of platelets were not transfused according to recent guidelines at Landspítali. Although our results are in line with findings of other studies it appears that the use of blood components in Icelandic ICUs can be improved. Key words: Blood transfusion, intensive care unit, red blood cells, fresh frozen plasma, platelets, transfusion clinical guidelines.