Intensive Care Medicine

, Volume 36, Issue 7, pp 1138–1146 | Cite as

Transfusion practice and guidelines in Australian and New Zealand intensive care units

  • The Blood Observational Study Investigators on behalf of the ANZICS-Clinical Trials GroupEmail author



To describe the relationship between clinical practice and national guidelines for the transfusion of red blood cells (RBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate in Australian and New Zealand intensive care units (ICUs).


Forty-seven ICUs over a 5-week period from August to September 2008.


Prospective, observational, multicentre, cohort study.


A total of 874 patients receiving any type of blood transfusion.


All patients who were transfused at least one unit of any blood component were included. Patient-specific and blood-component specific data were gathered. Pre-transfusion haemoglobin, platelet count, international normalised ratio (INR), and fibrinogen levels were compared to national guidelines.


Of all 874 patients, 757 received RBCs (86.6%), 231 (26.4%) received platelets, 340 (38.9%) received FFP, and 78 (8.9%) received cryoprecipitate. Bleeding was the reason for administration of RBCs in 46%, FFP in 55%, and platelets in 47% of transfusions. The mean (SD) pre-transfusion haemoglobin was 77.6 (9.5) g/l, while the geometric means (95% CI) for platelet count, INR, and fibrinogen were 67.0 (59.7–75.3) × 109/l, 1.84 (1.76–1.93), and 1.4 (1.1–1.8) g/l, respectively. The proportions of transfusions not adherent to guidelines were 2% for RBC, but 53% for platelets, 29% for FFP, and 88% for cryoprecipitate (RBC vs. other transfusion p < 0.001 for all).


Transfusion practice of RBCs in Australian and New Zealand ICUs is restrictive and is concordant with guidelines. However, the transfusion of other blood components is not.


Transfusion Red blood cells Fresh frozen plasma Platelets Cryoprecipitate Indication 



We would like to thank Australian Red Cross Blood Service and the New Zealand Blood Service for excellent collaboration during this study, and the Executive Committee of ANZICS Clinical Trials Group for review and publication endorsement of this study. An unrestricted grant was provided from the Australian Red Cross Blood Service, and the Australian and New Zealand Intensive Care Research Centre.


  1. 1.
    Marik PE, Corwin HL (2008) Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 36:2667–2674CrossRefPubMedGoogle Scholar
  2. 2.
    Vamvakas EC, Blajchman MA (2009) Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 113:3406–3417CrossRefPubMedGoogle Scholar
  3. 3.
    Khan H, Belsher J, Yilmaz M, Afessa B, Winters JL, Moore SB, Hubmayr RD, Gajic O (2007) Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 131:1308–1314CrossRefPubMedGoogle Scholar
  4. 4.
    (2001) Council NHAMR: Clinical practice guidelines on the use of blood components (red blood cells, platelets, fresh frozen plasma, cryoprecipitate) at http://www.Nhmrc.Gov.Au/publications/synopses/_files/cp78
  5. 5.
    Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507CrossRefPubMedGoogle Scholar
  6. 6.
    French CJ, Bellomo R, Finfer SR, Lipman J, Chapman M, Boyce NW (2002) Appropriateness of red blood cell transfusion in Australasian intensive care practice. Med J Aust 177:548–551PubMedGoogle Scholar
  7. 7.
    (1996) Practice guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on blood component therapy. Anesthesiology 84:732–747Google Scholar
  8. 8.
    (2006) Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on perioperative blood transfusion and adjuvant therapies. Anesthesiology 105:198–208Google Scholar
  9. 9.
    Murphy MF, Wallington TB, Kelsey P, Boulton F, Bruce M, Cohen H, Duguid J, Knowles SM, Poole G, Williamson LM (2001) Guidelines for the clinical use of red cell transfusions. Br J Haematol 113:24–31CrossRefPubMedGoogle Scholar
  10. 10.
    Welte M (2009) [Erythrocyte transfusion: update of the guidelines “therapy with blood components and plasma derivatives”]. Anaesthesist 58:1150–1158Google Scholar
  11. 11.
    Metz J, McGrath KM, Copperchini ML, Haeusler M, Haysom HE, Gibson PR, Millar RJ, Babarczy A, Ferris L, Grigg AP (1995) Appropriateness of transfusions of red cells, platelets and fresh frozen plasma. An audit in a tertiary care teaching hospital. Med J Aust 162: 572–573, 576–577Google Scholar
  12. 12.
    Schofield WN, Rubin GL, Dean MG (2003) Appropriateness of platelet, fresh frozen plasma and cryoprecipitate transfusion in New South Wales public hospitals. Med J Aust 178:117–121PubMedGoogle Scholar
  13. 13.
    Qureshi H, Lowe D, Dobson P, Grant-Casey J, Parris E, Dalton D, Hickling K, Waller F, Howell C, Murphy MF (2007) National comparative audit of the use of platelet transfusions in the UK. Transfus Clin Biol 14:509–513CrossRefPubMedGoogle Scholar
  14. 14.
    Benhamou D (2007) The use of fresh frozen plasma (FFP) in 2007 in France. Transfus Clin Biol 14:557–559CrossRefPubMedGoogle Scholar
  15. 15.
    Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Epidemiology 18:805–835CrossRefPubMedGoogle Scholar
  16. 16.
    Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical care trials group. N Engl J Med 340:409–417CrossRefPubMedGoogle Scholar
  17. 17.
    Deans KJ, Minneci PC, Suffredini AF, Danner RL, Hoffman WD, Ciu X, Klein HG, Schechter AN, Banks SM, Eichacker PQ, Natanson C (2007) Randomization in clinical trials of titrated therapies: unintended consequences of using fixed treatment protocols. Crit Care Med 35:1509–1516CrossRefPubMedGoogle Scholar
  18. 18.
    Nichol AD, Westbrook A, Bellomo R, Cooper DJ (2008) Is it too early to recommend a restrictive transfusion strategy in critically ill patients with ischemic heart disease? Crit Care Med 36:3126–3127CrossRefPubMedGoogle Scholar
  19. 19.
    Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ (2004) The CRIT study: anemia and blood transfusion in the critically ill-current clinical practice in the United States. Crit Care Med 32:39–52CrossRefPubMedGoogle Scholar
  20. 20.
    Dietrich GV, Schueck R, Menges T, Kiesenbauer NP, Fruehauf AC, Marquardt I (1998) Comparison of four methods for the determination of platelet function in whole blood in cardiac surgery. Thromb Res 89:295–301CrossRefPubMedGoogle Scholar
  21. 21.
    Velik-Salchner C, Maier S, Innerhofer P, Kolbitsch C, Streif W, Mittermayr M, Praxmarer M, Fries D (2009) An assessment of cardiopulmonary bypass-induced changes in platelet function using whole blood and classical light transmission aggregometry: the results of a pilot study. Anesth Analg 108:1747–1754CrossRefPubMedGoogle Scholar
  22. 22.
    Iorio A, Basileo M, Marchesini E, Materazzi M, Marchesi M, Esposito A, Palazzesi GP, Pellegrini L, Pasqua BL, Rocchetti L, Silvani CM (2008) The good use of plasma. A critical analysis of five international guidelines. Blood Transfus 6:18–24PubMedGoogle Scholar
  23. 23.
    O’Shaughnessy DF, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, Yates S, Williamson LM (2004) Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol 126:11–28CrossRefPubMedGoogle Scholar
  24. 24.
    (2003) [Transfusion with fresh frozen plasma: products, indications]. Ann Fr Anesth Reanim 22:252–261Google Scholar
  25. 25.
    Expert Working Group (1997) Guidelines for red blood cell and plasma transfusion for adults and children. CMAJ 156 (11 Suppl):S1–S24Google Scholar
  26. 26.
    Reverberi R (2008) Plasma, guidelines, and evidence-based medicine. Blood Transfus 6:3–5PubMedGoogle Scholar
  27. 27.
    Alport EC, Callum JL, Nahirniak S, Eurich B, Hume HA (2008) Cryoprecipitate use in 25 Canadian hospitals: commonly used outside of the published guidelines. Transfusion 48:2122–2127CrossRefPubMedGoogle Scholar
  28. 28.
    (2003) Guidelines for the use of platelet transfusions. Br J Haematol 122:10–23Google Scholar

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© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • The Blood Observational Study Investigators on behalf of the ANZICS-Clinical Trials Group
    • 1
    Email author
  1. 1.MelbourneAustralia

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