How to Use Blood and Blood Products

This chapter discusses the available evidence for blood transfusions in various subgroups of critically ill patients and other common issues pertaining to the transfusion of blood and blood components in the ICU. While blood and blood products can a be lifesaving therapy, the decision to transfuse should be based on individual factors, and the risk–benefit ratio of adverse events should be considered. Restrictive red blood cell (RBC) transfusion strategies are generally more beneficial, and platelet transfusions should be administered after risk assessment for bleeding, cause and pattern of thrombocytopenia, and presence of underlying comorbidities. Point-of-care tests such as thromboelastography (TEG) or rotational thromboelastometry (ROTEM) can help guide blood transfusions. Common transfusion reactions in the ICU include transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and nosocomial infections. Transfusion alternatives such as IV iron, erythropoietin, and tranexamic acid should be considered whenever feasible.