Anemia and RBC Transfusion

  • Paul Ellis Marik


Anemia is common in critically ill patients. More than 90% of patients have subnormal hemoglobin by the third day of ICU admission. Despite the fact that blood transfusions have not been shown to improve the outcome of ICU patients (see below) and that the current guidelines recommend blood transfusion only when the hemoglobin falls below 7.0 g/dl, almost half of all patients admitted to an ICU receive a blood transfusion.1,2 The etiology of anemia of critical illness is multi-factorial and complex. Repeated phlebotomy, gastrointestinal blood loss, and other surgical procedures contribute significantly to the development of anemia. Red cell production in critically ill patients is often abnormal and is involved in the development and maintenance of anemia. The pathophysiology of this anemia includes decreased production of erythropoietin (EPO), impaired bone marrow response to erythropoietin, and reduced red cell survival.


Blood Transfusion West Nile Virus Transfusion Trigger Gastrointestinal Blood Loss Hemolytic Reaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Corwin HL, Gettinger A, Pearl RG, et al. The CRIT Study: Anemia and blood transfusion in the critically ill – current clinical practice in the United States. Crit Care Med. 2004;32:39–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Vincent JL, Baron JF, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288:1499–1507.PubMedCrossRefGoogle Scholar
  3. 3.
    Busch MP, Kleinman SH, Nemo GJ. Current and emerging infectious risks of blood transfusions. JAMA. 2003;289:959–962.PubMedCrossRefGoogle Scholar
  4. 4.
    Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest. 2005;127:295–307.PubMedCrossRefGoogle Scholar
  5. 5.
    Beck I, Scott JS, Pepper M, et al. The effect of neonatal exchange and later blood transfusion on lymphocyte cultures. Am J Reproduct Immunol. 1981;1:224–225.Google Scholar
  6. 6.
    Marik PE, Sibbald WJ. Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA. 1993;269:3024–3029.PubMedCrossRefGoogle Scholar
  7. 7.
    Marik PE, Corwin HL. Efficacy of RBC transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008; 36:2667–2674.PubMedCrossRefGoogle Scholar
  8. 8.
    Marik PE, Corwin HL. Acute lung injury following blood transfusion: expanding the definition. Crit Care Med. 2008;36:3080–3084.PubMedCrossRefGoogle Scholar
  9. 9.
    Weiskopf RB, Viele MK, Feiner J, et al. Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA. 1998;279:217–221.PubMedCrossRefGoogle Scholar
  10. 10.
    Leung JM, Weiskopf RB, Feiner J, et al. Electrocardiographic ST-segment changes during acute, severe isovolemic hemodilution in humans. Anesthesiol. 2000;93:1004–1010.CrossRefGoogle Scholar
  11. 11.
    Levy PS, Kim SJ, Eckel PK, et al. Limit to cardiac compensation during acute isovolemic hemodilution: influence of coronary stenosis. Am J Physiol. 1993;265:H340–H349.PubMedGoogle Scholar
  12. 12.
    Hebert PC, Wells G, Blajchman MA, et al. 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. 1999;340:409–417.PubMedCrossRefGoogle Scholar
  13. 13.
    Hebert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med, 2001;29:227–234.PubMedCrossRefGoogle Scholar
  14. 14.
    Consensus conference. Perioperative red blood cell transfusion. JAMA. 1988;260:2700–2703.Google Scholar
  15. 15.
    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. Anesthesiol. 2008;105:198–208.Google Scholar
  16. 16.
    Expert Working Group. Guidelines for red blood cell and plasma transfusion for adults and children. Can Med Assoc J. 2008;156(11 (suppl.):S1–S24.Google Scholar
  17. 17.
    Nikolsky E, Aymong ED, Halkin A, et al. Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. J Am Coll Cardiol. 2004;44:547–553.PubMedCrossRefGoogle Scholar
  18. 18.
    Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol. 2003;41:1933–1939.PubMedCrossRefGoogle Scholar
  19. 19.
    Rao SV, Jollis JG, Harrington RA, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA. 2004;292:1555–1562.PubMedCrossRefGoogle Scholar
  20. 20.
    Aronson D, Dann EJ, Bonstein L, et al. Impact of red blood cell transfusion on clinical outcomes in patients with acute myocardial infarction. Am J Cardiol. 2008;102:115–119.PubMedCrossRefGoogle Scholar
  21. 21.
    Jani SM, Smith DE, Share D, et al. Blood transfusion and in-hospital outcomes in anemic patients with myocardial infarction undergoing percutaneous coronary intervention. Clin Cardiol. 2007;30:II49–II56.PubMedCrossRefGoogle Scholar
  22. 22.
    Singla I, Zahid M, Good CB, et al. Impact of blood transfusions in patients presenting with anemia and suspected acute coronary syndrome. Am J Cardiol. 2007;99:1119–1121.PubMedCrossRefGoogle Scholar
  23. 23.
    Alexander KP, Chen AY, Wang TY, et al. Transfusion practice and outcomes in non-ST-segment elevation acute coronary syndromes. Am Heart J. 2008;155:1047–1053.PubMedCrossRefGoogle Scholar
  24. 24.
    Twomley KM, Rao SV, Becker RC. Proinflammatory, immunomodulating, and prothrombotic properties of anemia and red blood cell transfusions. J Thromb Thrombolysis. 2006;21:167–174.PubMedCrossRefGoogle Scholar
  25. 25.
    Carson JL, Duff A, Poses RM, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348:1055–1060.PubMedCrossRefGoogle Scholar
  26. 26.
    Spence RK, Carson JA, Poses R, et al. Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality. Am J Surg. 1990;159:320–324.PubMedCrossRefGoogle Scholar
  27. 27.
    Marik PE. The hazards of blood transfusion. Br J Hosp Med. 2009;70:12–15.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations