Restrictive red blood cell transfusion strategies in critical care: does one size really fit all?

Anaemia is common in patients managed in intensive care units.1-4 It has been shown that 35 a??45 of ICU patients have anaemia sufficient to require red blood cell transfusion, and they receive on average almost 5 units.1,4 The causes of this anaemia are multifactorial and include blood loss, haemodilution, and the anaemia of critical illness, which reduces red blood cell production.1-4 Controversially, red blood cell transfusions have been used to improve the peripheral delivery of oxygen,5 even in patients with haemoglobin (Hb) concentrations more than 100 g/L.6,7 More recently, early goal-directed therapy a?? a component of the current 2008 Surviving Sepsis guidelines for critically ill patients with severe sepsis and septic shock a?? includes as a target maintaining the haematocrit over 30 .8,9