Chapter 22. Anemia and RBC Transfusion in the ICU

Karl W Thomas, MD, FCCP
DOI: 10.1378/critcare.21.22
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  • Discuss the pathophysiology and causes of anemia in ICU patients.

  • Describe the indications and appropriate clinical use of RBC transfusion.

  • Describe the positive and negative associations of RBC transfusion with ICU outcomes.

  • Discuss the specific risks associated with RBC transfusion, including disease transmission.

  • Discuss the components of blood transfusion management and surveillance programs.


Anemia and RBC transfusion are common in critically ill, surgical, and trauma patients. In the ICU, anemia may occur within the context of exaggerated blood loss through hemorrhage or phlebotomy, intravascular hemolysis, and disordered RBC production. Although anemia has been associated with worse ICU outcomes including length of stay, ventilator days, and mortality, correction of anemia through RBC transfusion has also been associated with these worse outcomes. The most appropriate clinical response to anemia requires systematic evaluation for underlying cause, determination of physiologic status, and careful consideration of transfusion risks. This chapter focuses on the clinical evaluation and management of anemia and RBC transfusion and reviews the pathophysiology, epidemiology, and expected risks and benefits of RBC transfusion in ICU populations.


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