Blood transfusions for symptoms, not numbers

The debate on what threshold to transfuse RBCs continues to burden many ICU intensivists, mainly with the question being posed, 'Why are we transfusing?' In the emergency department this is less of an issue given our patient population who often present with low hemoglobin and some sort of symptom that brought them in ( 'Doc I have been having increasing chest pain when I walk up stairs lately, I think it's all the stress lately'). MarylandCC brings the online community a top notch lecture by Dr. Giora Netzer who discusses the current literature in transfusion medicine and how we should be approaching the anemic patient. Should we transfuse a number or a patient? Listen up! 

And if you need a quick refresh on the TRICC (Transfusion Requirements in Critical Care) trial here are the basics:

• Study Design: Multi-centered RCT
• Population: 838 euvolemic critically ill patients admitted to ICU for > 24 hours with a measured hemoglobin of < 9.0 within 72 hours after admission

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• Intervention protocol: Restrictive-strategy transfusion (Hgb >7.0) vs liberal-strategy transfusion (Hgb >10.0)
• Outcome Measures: Primary outcome measures was death from all causes in 30 days. Secondary Outcomes included 60 day death from all causes, mortality rates during the stay in the intensive care unit and during hospitalization and survival times in the first 30 days. 
• Results: All cause death at 30 days after admission to the intensive care unit: 18.7% in the restrictive-strategy group and 23.3% percent in the liberal-strategy group.  

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Original Article

What's ahead...

• Transfusion Requirements in Septic Shock (TRISS): Multicenter RCT in Scandinavian ICU setting