An appraisal of blood transfusion practices in the intensive care units of Imam Hossein hospital in comparison with international strategies during 2010-2014

Background and Aims: Blood transfusion is commonly used for patients in intensive care units (ICU), and physicians usually decide to order blood transfusion according to the hemoglobin (Hb) level. In this regard, various strategies for blood transfusions, including liberal and restrictive transfusion strategies, are presented on the basis of Hb level threshold. Considering the importance of blood transfusions in the ICU, the current study aimed to appraise blood transfusion practices in the ICU of Imam Hossein hospital in comparison with international strategies during 2010-2014.

Methods: This retrospective cohort study was conducted in the ICU of Imam Hussein hospital. The medical files of all patients older than 18 years admitted to the ICU during 2010-2014 were examined. Patients' demographic and clinical information and data about the blood transfusion were collected in the checklist. Finally, by using appropriate statistical analysis, the patterns of blood transfusion in the ICU were determined and compared with international strategies.

Results: In this study, 654 patients were hospitalized in the ICU, of which 327 patients did not receive any blood transfusion and 327 patients received blood transfusion. Among the 327 patients who received blood transfusion, 62 patients (19%) had a hemoglobin (Hb) less than 7, and were indeed transfused by restrictive strategy. Also, 220 patients (67.2 %) had Hb between 7 and 10, and 45 patients (13.8 %) had Hb more than 10. Patients who received blood transfusion were hospitalized significantly for more days in the ICU and had significantly more days under mechanical ventilation (p=0.001). In this study, 58 patients had anemia, all of whom had Hb less than 7. The death rate recorded in the study showed no significant difference between groups according to Hb level (p=0.56), although a higher percentage of deaths were recorded in patients with Hb less than 7.

Conclusion: In this study, 19% of the patients who received blood transfusion had Hb less than 7, and were transfused by the restrictive transfusion strategy. This is while the clinical outcomes of blood transfusion in patients with different Hb levels was not significantly different. Therefore, it seems that blood transfusion in Imam Hossein hospital is not according to the international strategy of blood transfusion. Given the importance of blood transfusions in the ICU, measurements to comply with standard strategies is necessary.