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Transfusion de concentrés globulaires en réanimation : moins, c’est mieux !

Transfusion of red blood cells in the ICU: less is better!

  • Session Thématique
  • Published:
Réanimation

Résumé

Le développement d’une anémie euvolémique est un événement fréquent chez les patients de réanimation, parfois favorisé par une pathologie sous-jacente, mais plus souvent liée à une altération de l’érythropoïèse et à des spoliations sanguines répétées. De fait, les patients hospitalisés en réanimation sont fréquemment exposés à des transfusions de concentrés de globules rouges (CGR). Depuis la publication en 1999 de l’étude-pivot TRICC, les indications de transfusion de CGR en réanimation ont privilégié une stratégie restrictive visant à maintenir un taux d’hémoglobine > 7 g.dL−1. En effet, la transfusion de CGR semble être grevée d’effets indésirables majeurs en réanimation, tels qu’une susceptibilité accrue aux infections nosocomiales voire une augmentation de la mortalité. L’amélioration de la qualité des produits sanguins labiles par la déleucocytation, systématique en France, ou la limitation de la durée de stockage pourrait contribuer à une amélioration de la sécurité transfusionnelle dans ce contexte. L’objectif de cette mise au point est de rappeler les indications et les risques de la transfusion de CGR en réanimation, à l’exclusion du choc hémorragique.

Abstract

Anemia is a common problem in critically ill patients, sometimes driven by some underlying comorbidities, but most often related to alterations in erythropoiesis and repeated blood loss and draws. Hence patients in the intensive care unit (ICU) are frequently prone to red blood cell (RBC) transfusions. Since the publication in 1999 of the pivotal study TRICC, indications of RBC transfusions have generally been restricted to maintain a haemoglobin level above 7 g.dL−1. RBC transfusion is likely to be associated with serious adverse side-effects such as increased susceptibility to nosocomial infections and increased mortality rate. Quality improvements in blood products through leucodepletion and shorter durations of storage may contribute to improve the safety of RBC transfusion. The present article aims to review the current indications and potential risks of RBC transfusion in the ICU, excluding haemorrhagic shock.

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Authors and Affiliations

  1. Service de réanimation médicale, hôpital Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, F-75014, Paris, France

    B. Champigneulle & F. Pène

  2. Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    B. Champigneulle & F. Pène

  3. Département 3i, Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France

    F. Pène

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  1. B. Champigneulle
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  2. F. Pène
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Correspondence to F. Pène.

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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2015 dans la session : Moins c’est mieux !

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Champigneulle, B., Pène, F. Transfusion de concentrés globulaires en réanimation : moins, c’est mieux !. Réanimation 24 (Suppl 2), 361–370 (2015). https://doi.org/10.1007/s13546-014-1015-5

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