Red cell transfusion practice following the transfusion requirements in critical care (TRICC) study: prospective observational cohort study in a large UK intensive care unit

Abstract

Background and Objectives The Transfusion Requirements In Critical Care (TRICC) study found that critically ill patients tolerate a restrictive haemoglobin transfusion threshold. We investigated red‐cell transfusion practice since publication of the TRICC study in a large Scottish teaching hospital intensive care unit (ICU). Materials and Methods We prospectively collected daily data for a 6‐month period on haemoglobin concentrations, red‐cell transfusions and indications for transfusions, throughout ICU stay for all patients who stayed for longer than 24 h in the ICU. Results A total of 176 patients were studied, who utilized 1237 ICU days. Of these 176 patients, 52% received red‐cell transfusions. A haemoglobin concentration of ≤ 9 g/dl was measured in 55% of patients; this occurred by day 1 and day 2 in 52% and 77% of these cases, respectively. Overall the haemoglobin concentration was ≤ 9 g/dl for 45% of all patient days. Total red‐cell use was 3·1 units per admission (0·47 units per patient day). Only 18% of transfusion episodes were required as a result of haemorrhage. For ‘non‐haemorrhage’ transfusion episodes, the median pretransfusion haemoglobin concentration was 7·8 g/dl (interquartile range: 7·4–8·4 g/dl), and 64% of transfusion episodes were for 2 units. Conclusions Clinicians in our centre were conservative, in keeping with recent transfusion guidelines, but deviated from the TRICC protocol by transfusing at haemoglobin concentrations of between 7 and 9 g/dl, rather than below 7 g/dl, and by prescribing 2 unit transfusions. Significant numbers of red‐cell units are still used in the critically ill.