A review of 45 clinical studies evaluating RBC transfusions in critically ill patients, which included 272,596 patients, revealed the following findings (32):
1. In 42 of the 45 studies, the adverse effects of RBC transfusions outweighed any benefits.
2. Only 1 of 45 studies showed that the benefits of RBC transfusions outweighed the adverse effects.
3. Eighteen studies evaluated the relationship between RBC transfusions and survival, and 17 of the 18 studies showed that RBC transfusions were an independent risk factor for death. The likelihood of a fatal outcome was, on average, 70% higher in patients who received an RBC transfusion.
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Chapter 12
Platelets and Plasma
This chapter begins with a description of thrombocytopenia and platelet therapy in critically ill patients, and then focuses on the transfusion of plasma products, including recommendations for the rapid reversal of warfarin anticoagulation.
I. THROMBOCYTOPENIA
Thrombocytopenia is the most common hemostatic disorder in critically ill patients, with a reported incidence of up to 60% (1,2). Although thrombocytopenia is defined as a platelet count <150,000/àL, the ability to form a hemostatic plug is retained until the platelet count falls below 100,000/àL (2), so a platelet count <100,000/àL is more appropriate for identifying clinically significant thrombocytopenia.