When is transfusion therapy indicated in critical illness and when is it not?

Document Type

Journal Article

Publication Date



Evidence-Based Practice of Critical Care




Anemia; Coagulopathy; Hemorrhage; Platelet dysfunction; Thrombocytopathy


Transfusion therapy is ubiquitous in the intensive care unit, both as a means to optimize oxygen delivery as well as to maintain or restore appropriate coagulation. Coagulopathy and platelet dysfunction are reportedly common in severely injured or critically ill patients. The need to prioritize plasma transfusion in patients with trauma is established, and this practice has been extrapolated in noninjured, critically ill, bleeding patients as well. However, there are many risks associated with transfusion therapy, most of which can be broadly categorized as transfusion-related risks, such as volume overload, acute lung injury, and immunomodulation. More recently, pharmacologic agents, including recombinant factor VIIa, tranexamic acid, and prothrombin complex concentrates, are being used for reversal of coagulopathy in bleeding patients. Each of these agents is associated with a variable degree of risk of thromboembolism. It remains to be determined if the use of these agents can partly or fully supplant the need for plasma transfusion.