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journal article Feb 02, 2021

Effects of red blood cell transfusion on global oxygenation in anemic critically ill patients

Nicolas Themelin ORCID Patrick Biston Jacqueline Massart Christophe Lelubre Michaël Piagnerelli
Transfusion Vol. 61 No. 4 pp. 1071-1079 · Wiley
View at Publisher Save 10.1111/trf.16284
Abstract
AbstractBackgroundConsensus for transfusion in intensive care unit (ICU) patients recommends a restrictive strategy, based on a hemoglobin (Hb) concentration of 7 g/dL. Red blood cell (RBC) transfusion is used to prevent tissue hypoxia by improving oxygen transport (DO2) and therefore oxygen consumption (VO2). We studied the effects of RBC transfusion on systemic oxygenation parameters reflecting systemic oxygen extraction (EO2 = DO2/VO2): S(c)vO2, lactate level, venous‐to‐arterial carbon dioxide difference (Pv‐aCO2), and cardiac index/EO2 (CI/EO2) and evaluated their usefulness in guiding transfusion decisions in ICU patients.Study Design and MethodsProspectively, all adult patients transfused were included except those with active bleeding or without a jugular or subclavian catheter. We measured O2 parameters before and after transfusion. Patients were a priori grouped according to their initial S(c)vO2 (< or ≥70%), treatment with vasopressors, cardiac function, and septic status.ResultsA total of 62 patients received 105 RBC transfusions. For all, mean arterial pressure (77 [69‐88] to 81 [73‐91] mm Hg), Hb concentration (7.4 [7.0‐7.8] to 8.4 [7.7‐8.9] g/dL) and S(c)vO2 (65% [59%‐73%] to 69% [62%‐75%]) increased after transfusion (all P < .001). S(c)vO2 improved after transfusion only when initial S(c)vO2 was less than 70% (62% [56%‐65%] to 66% [61%‐71%]; P < .001). In this group, Pv‐aCO2, lactate concentrations, and CI/EO2 did not change after transfusion. Cardiac function, sepsis, or vasopressor therapy did not affect these results.ConclusionsAmong systemic O2 parameters, only a S(c)vO2 < 70% in anemic ICU patients improves after transfusion. As S(c)vO2 can reflect a DO2/VO2 imbalance, it could be helpful when combined with the Hb concentration to decide whether to transfuse. However, the benefit on outcome should be further studied.
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Cited By
17
Beyond hemoglobin thresholds: A physiology-guided framework for red blood cell transfusion in non-bleeding critically ill patients

Thanh Luan Nguyen, Quang Dai Le · 2026

Science Progress
Metrics
17
Citations
39
References
Details
Published
Feb 02, 2021
Vol/Issue
61(4)
Pages
1071-1079
License
View
Authors
N
Nicolas Themelin

Intensive Care, CHU‐Charleroi Marie‐Curie Université Libre de Bruxelles Charleroi Belgium

P
Patrick Biston

Intensive Care, CHU‐Charleroi Marie‐Curie Université Libre de Bruxelles Charleroi Belgium

J
Jacqueline Massart

Intensive Care, CHU‐Charleroi Marie‐Curie Université Libre de Bruxelles Charleroi Belgium

C
Christophe Lelubre

Internal Medicine CHU‐Charleroi Marie‐Curie, Université Libre de Bruxelles Charleroi Belgium

M
Michaël Piagnerelli

Intensive Care, CHU‐Charleroi Marie‐Curie Université Libre de Bruxelles Charleroi Belgium; Experimental Medicine Laboratory, CHU‐Charleroi, A Vésale Hospital, ULB 222 Unit Université Libre de Bruxelles Montigny‐le‐Tilleul Belgium

Cite This Article
Nicolas Themelin, Patrick Biston, Jacqueline Massart, et al. (2021). Effects of red blood cell transfusion on global oxygenation in anemic critically ill patients. Transfusion, 61(4), 1071-1079. https://doi.org/10.1111/trf.16284
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