Analytic Reviews : Red Cell Transfusion in a Critical Care Unit

The acquired immunodeficiency syndrome epidemic and recognition of human immunodeficiency virus transmission by blood products have increased concern over the risks of blood transfusion and generated discus sion on proper indications. To assess current practice with respect to red blood cell transfusion, we examined transfusion practices in a medical-surgical intensive care unit. The extensive clinical and physiological moni toring in this setting allowed us to examine indices of oxygen carrying capacity, oxygen delivery, tissue oxy genation, and their associations with subsequent trans fusion. We were unable to detect changes in hemody namic or tissue oxygenation measurements associated with transfusions. Tissue oxygenation measures were in frequently documented even in the presence of an in dwelling pulmonary artery catheter. Hemoglobin and hematocrit levels showed statistically significant de creases prior to initial and subsequent transfusions. He modynamic and tissue oxygenation indices available in intensive care settings merit further evaluation for use in the assessment of transfusion need.