Anaemia and red blood cell transfusion in the critically ill patient

Blood Rev. 2003 Dec;17(4):195-208. doi: 10.1016/s0268-960x(03)00018-3.


Anaemia is a common finding in critically ill patients. There are often multiple causes. Obvious causes include surgical bleeding and gastrointestinal haemorrhage but many patients have no overt bleeding episodes. Phlebotomy can be a significant source of blood loss. In addition, critically ill patients have impaired erythropoiesis as a consequence of blunted erythropoietin production and direct inhibitory effects of inflammatory cytokines. The ability of a patient to tolerate anaemia depends on their clinical condition and the presence of any significant co-morbidity; maintenance of circulating volume is of paramount importance. There is no universal transfusion trigger. Current guidelines for critically ill and perioperative patients advise that at Hb values <70 g/L red blood cell transfusion is strongly indicated and at Hb values >100 g/L transfusion is unjustified. For patients with Hb values in the range 70 to 100 g/L the transfusion trigger should be based on clinical indicators. Most stable critically ill patients can probably be managed with a Hb concentration between 70 and 90 g/L. Uncertainties exist concerning the most appropriate Hb concentration for patients with significant cardio-respiratory disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anemia / etiology*
  • Anemia / physiopathology
  • Anemia / therapy*
  • Critical Illness
  • Erythrocyte Transfusion / adverse effects
  • Erythrocyte Transfusion / standards*
  • Erythropoiesis / drug effects
  • Erythropoiesis / physiology
  • Erythropoietin / therapeutic use
  • Humans
  • Recombinant Proteins


  • Recombinant Proteins
  • Erythropoietin