Update in Critical Care for the Nephrologist: Transfusion in Nonhemorrhaging Critically Ill Patients

A growing number of guidelines and recommendations advocate a restrictive transfusion strategy. Strong evidence exists that a hemoglobin threshold of lessthan 7 g/dL conserves resources and may improve outcomes in critically ill patients and that platelet counts greater than 10,000/mu L are well tolerated. Patients with coronary artery disease can be safely managed with a restrictive transfusion strategy, utilizing a hemoglobin threshold of lessthan 7 or 8 g/dL; a threshold of lessthan 8 g/dL can be applied to patients with acute coronary syndromes. In the absence of coagulopathy with bleeding or high risk for bleeding, plasma transfusion should be withheld. Complications from transfusion are significant and previously under-recognized immunologic complications pose a more serious threat than infections. Erythropoietin and iron administration do not reduce transfusion needs in the critically ill. Interventions to reduce blood loss and educate clinicians are successful in reducing transfusion requirements. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.