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6 - Frequency and threshold of the erythrocyte suspension transfusion in the intensive care unit
Mehmet Eren Açık, Hacer Şebnem Türk, Canan Tülay Işıl, Naim Ediz, İnci Paksoy, Merih Tombul, Sibel Oba
Objective: Some studies showed that increased blood transfusion is associated with prolonged Intensive Care Unit (ICU) stay and higher mortality rates. However, it is well known that anemia increases tissue hypoxia in the critically ill patient. In this study we aimed to discuss transfusion frequency and threshold values of transfusion in our ICU.
Material and Metods: Data of 237 patients hospitalized in the ICU of Sisli Etfal Training and Research Hospital with 7 bed capacity during the year 2011 were analyzed retrospectively. Age, gender, APACHE II risk-score, ICU stay, blood transfusion amount, hemoglobin (Hb) level before transfusion and mortality was recorded.
Results: The age of patients age was 44.76±18.55 years, male/female ratio was 130/107 APACHE II score was 18.56±8.12. ICU stay was 10.79±9.87 days. Totally 183 patients were transfused 252 Units of red blood cells (RBC). The Mean Hb level was 8.62±2.2g/dl in the transfused patients. 68 patients were transfused with Hb <7g/dl, RBC/patient ratio was 69/68, APACHE II score was 17.67±7.21, ICU stay was 10.83±8.42 days and mortality was 33.8% (n=23). 43 patients received transfusion with a Hb <8 g/dl, RBC/patient ratio was 45/43, APACHE II score was 16.21±5.23, ICU stay was 10.76±8.96 days and 41.8% (n=18) died. 52 patients received transfusion with Hb <9 g/dl, RBC/patient ratio was 103/52, APACHE II score was 23.57±4.12, ICU stay was 13.63±10.2 days and mortality was 73% (n=38). 20 patients were transfused with Hb <10 g/dl, RBC/patient ratio was 35/20, APACHE II score was 24.33±2.12, ICU stay was 19.03±12.67 days and 65% (n=13) died. ICU stay of non-transfused 54 patients was 10.81±7.63 days and 42.5% (n=23) was died. APACHE II score was 17.78±6.7.
Conclusions: While ICU stay was not prolonged and mortality was not increased in the patients transfused with a Hb level of 7-8 g/dl which was similiar to the non-transfused patients, it was just the opposite in patients recieving transfusion with Hb level 9-10g/dl. In our opinion, applying a restrictive blood transfusion protocol in the ICU looks like a better strategy for prolonging life. But we also think that further studies on tissue oxigenation should be conducted.
Keywords: Blood transfusion, intensive care unit, anemia
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