The majority of ICU patients are anaemic. Anaemia is associated with worse outcomes and a necessity for red blood cell transfusions. ICU patients are a heterogeneous patient group with a broad spectrum of main diagnoses and comorbidities. Evidence-based transfusion trigger guidelines have been established that are dependent on comorbidities. Special attention has been given to blood saving measures and point-of-care diagnosis of coagulation disorders in ICU patients. The administration of intravenous iron and erythropoiesis-stimulating agents can provide useful and individualised alternatives to the administration of red blood cell concentrates in treatment of iron deficiency anaemia. In presence of inflammation and infection, it is challenging to identify the cause of anaemia. The hepcidin-ferroportin pathway may facilitate the diagnosis of anaemia in ICU patients and indicate novel targets in anaemia treatment.
This review article presents patient blood management measures and summarises the current literature on transfusion thresholds and alternative therapeutic options using intravenous iron and erythropoiesis-stimulating agents with a key focus on the ICU.
- A restrictive transfusion strategy – considering individual compensation mechanisms – should be applied in a guideline-compliant approach.
- The administration of intravenous iron and erythropoiesis-stimulating agents can be useful alternatives to RBC administration for non-emergency cases in iron deficiency anaemia but not for immediate oxygen support supply.
- Reduction of iatrogenic blood loss and measures for haemostasis and coagulopathy are of great importance for ICU patients.