Blood Product Transfusions
Red Blood Cells
- See RBC Transfusion Thresholds. In a nutshell, for most critically ill patients, >70 g/L is appropriate transfusion threshold.
- No recommendations per ESICM on: ECMO, acute neurologic injury, oncology patients, elderly patients.
- Recommend not using EPO or combined EPO + iron.
Platelets
Very little evidence for critically ill patients. ESICM guidelines from 2020 suggest:
| Group | Threshold |
|---|---|
| Not actively bleeding | > 10 |
| Prophylactic platelet procedures at low risk of bleeding (tracheostomy, PEG, central line) | 50 to 100 |
| Neurosurgical or other invasive procedure (lumbar puncture etc) | > 100 |
Plasma Transfusion
- Do not give prophylactic plasma transfusions to non-bleeding patients with coagulopathy (conditional, very low evidence)
- Do not give prophylactic plasma transfusions to non-bleeding patients undergoing invasive procedures.
References
- Blood product transfusion in nonbleeding critically ill patients. New CPGs. Part 1
- Blood product transfusion in nonbleeding critically ill patients. New CPGs. Part 2
- Transfusion strategies in nonbleeding critically ill adults: European guidelines in a nutshell. Part 1
- Evidence-based Transfusion Practice and Blood Management Programs (Video)
- Vlaar AP, Oczkowski S, de Bruin S, et al. Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med. 2020;46(4):673-696. doi:10.1007/s00134-019-05884-8