The Transfusion Requirements in Critical Care Trial (TRICC) was a multi-center prospective randomized controlled clinical trial conducted in Canada in 1999, which compared the clinical outcomes in intensive care patients randomized to a restrictive versus a liberal transfusion strategy (NEJM 1999; 340: 409-17). Patients in the restrictive cohort were transfused when their hemoglobin concentration fell below 7 g/dL and their hemoglobin was maintained between 7-9 g/dL, while patients in the liberal transfusion group were transfused when their hemoglobin concentration fell below 10 g/dL and their hemoglobin was maintained between 10-12 g/dL.
Outcomes |
Liberal |
Restrictive |
#Patients |
420 |
418 |
#RBC units |
5.2+/-4.9 |
2.5+/-3.8 |
Transfusion avoidance |
0% |
33% |
ICU stay |
11.5 days |
11.0 days |
30 day survival |
77% |
81% |
60 day survival |
74% |
77% |
The TRICC trial demonstrated that a more restrictive transfusion strategy was safe in the ICU patient population and that the liberal use of transfusions increased the risk of death. Multiple other studies have subsequently demonstrated that allogeneic transfusions cause immunomodulation leading to increased ICU and hospital length of stay as well as nosocomial infections and mortality.
Transfusion medicine has evolved over the last few years. Because allogeneic transfusions are a potential risk for patients, physicians should attempt to limit transfusions by aggressively preventing anemia in hospitalized patients. The decision to transfuse RBCs should be based on the entire clinical picture and not solely on the hemoglobin level. Current transfusion guidelines are available on this web site.
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