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Anemia and Blood Transfusion in Trauma Patients Admitted to the Intensive Care Unit

Shapiro, Marc J. MD; Gettinger, Andrew MD; Corwin, Howard L. MD; Napolitano, Lena MD; Levy, Mitchell MD; Abraham, Edward MD; Fink, Mitchell P. MD; MacIntyre, Neil MD; Pearl, Ronald G. MD, PhD; Shabot, M. Michael MD

The Journal of Trauma: Injury, Infection, and Critical Care: August 2003 - Volume 55 - Issue 2 - p 269-274
doi: 10.1097/01.TA.0000080530.77566.04
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Background  Anemia is a common occurrence in the intensive care unit (ICU). Although resuscitation, including the use of blood, is a mainstay of early treatment of trauma victims, the safety and efficacy of red blood cell (RBC) transfusion has come under scrutiny recently. The issue of blood use in critically injured patients requires evaluation.

Methods  This was a post hoc analysis of a subset of trauma patients (≥18 years in age) from a prospective, multicenter, observational, cohort study in the United States. Patients were enrolled within 48 hours after ICU admission and followed for up to 30 days, or until hospital discharge or death.

Results  Five hundred seventy-six patients from 111 ICUs in 100 hospitals were enrolled between August 2000 and April 2001. At baseline, mean age was 44.1 ± 20.2 years, 73.6% were men, and mean APACHE II score was 16.9 ± 8.2. Mean baseline hemoglobin was 11.1 ± 2.4 g/dL and patients remained anemic throughout the study either with or without transfusion; 55.4% of patients were transfused (mean, 5.8 ± 5.5 units) during the ICU stay and 43.8% of patients had an ICU length of stay ≥ 7 days. Mean pretransfusion hemoglobin was 8.9 ± 1.8 g/dL. Mean age of RBCs transfused was 20.1 ± 11.4 days. As compared with the full study population, patients in the trauma subset were more likely to be transfused and received an average of 1 additional unit of blood.

Conclusion  Anemia is common in critically injured trauma patients and persists throughout the duration of critical illness. These patients receive a large number of RBC transfusions during their ICU course with aged blood.

From the Department of Surgery, Saint Louis University (M.J.S.), St. Louis, Missouri, Departments of Anesthesiology (A.G.) and Medicine (H.L.C.), Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, Department of Surgery, University of Maryland (L.N.), Baltimore, Maryland, Department of Medicine, Rhode Island Hospital (M.L.), Providence, Rhode Island, Department of Medicine, University of Colorado (E.A.), Denver, Colorado, Department of Critical Care Medicine, University of Pittsburgh Medical Center (M.P.F.), Pittsburgh, Pennsylvania, Department of Medicine, Duke University Medical Center (N.M.), Durham, North Carolina, Department of Anesthesiology, Stanford University Medical Center (R.G.P.), Palo Alto, and Department of Surgery, Cedars-Sinai Medical Center (M.M.S.), Los Angeles, California.

Submitted for publication April 29, 2003.

Accepted for publication May 15, 2003.

Supported by Ortho Biotech Products, L.P.

Presented at the 16th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 15–18, 2003, Ft. Myers, Florida.

Address for reprints: Marc J. Shapiro, MD, FACS, FCCM, Department of Surgery, Saint Louis University, 3635 Vista at Grand Blvd., St. Louis, MO 63110-0250; email: shapirom@slu.edu.

© 2003 Lippincott Williams & Wilkins, Inc.