Introduction: Critically sick patients admitted to the Intensive Care Unit (ICU) frequently suffer from anemia. Anemia is defined by the World Health Organization (WHO) as hemoglobin (Hb) < 13g/dl in men and < 12g/dl in women. Aims: To evaluate the morbidity and mortality of adult transfused patients and to establish transfusion protocols for all components—PC, FFP, and PLTC—among critically sick patients. Materials & Methods: The present study was a hospital based observational descriptive study. This Study was conducted from eighteen months after ethical clearance from March 2021 to September 2022 at ICU, IQ CITY Medical College and Hospital, Durgapur. Total 218 patients were included in this study. Result: Out of 44 (80.0%) patients who died had received PRBC transfusion, 1 (1.8%) who died patient had received PRBC+FFP transfusion, 1 (1.8%) patient who died patient had CRBC+FFP+PC transfusion, 8 (14.5%) patients who died had FFP transfusion, and 1 (1.8%) patient who died had PC transfusion. Association of BLOOD COMPONENT with Mortality was not statistically significant (p=0.0634) as shown in table 25 and figure 22. Conclusion: We came to the conclusion that, even if blood transfusions are essential in intensive care units, it is crucial to use blood components with caution, evidence, and individualization. This would guarantee that blood products are utilized safely and effectively in critically ill patients, minimize possible dangers, and improve patient care.
Critically sick patients admitted to the Intensive Care Unit (ICU) frequently suffer from anemia. Anemia is defined by the World Health Organization (WHO) as hemoglobin (Hb) < 13g/dl in men and < 12g/dl in women [1]. Red blood cell transfusion is often administered to improve oxygen content and hence restore adequate oxygen reserve [2]. Additionally, RBC transfusion is linked to acute lung injury, transfusion-related immunomodulation, alloimmunization, and microcirculatory dysfunction, all of which increase mortality, lengthen hospital stays, and cause sepsis organ failure [2]. Numerous studies have attested to risks outweighing the benefits of such transfusion. Few studies document that increase in anaemia was assosciated with increase in mortality rates in patients with ischaemic heart desease(Carson , Herbert ) .
Much controversy exists on fresh frozen plasma transfusion. Widely regarded as an unfailing measure to correct prolonged coagulation tests, transfusion of fresh frozen plasma as been shown to be of little help to rectify mild increments of INR [3]. The main indications of FFP transfusion is heavy bleeding and to control bleeding in planned invasive procedure.
Common risks assosciated with FFP include transfusion associated acute injury, transfusion assosciated circulatory overload, allergic or anaphylactic reactions, transmission of infections and others though most of the adverse reactions are not lethal (suchitra pandey et al2012)[4].
Thrombocytopenia is common in ICU. Patients admitted to ICU have a 35-45% incidence of developing thrombocytopenia and 15-30%may be administered the platelet component. Platelet content are transfused to alleviate the risk of bleeding in complex coagulation defects, anticipated surgery in patients taking antiplatelet agents or with renal insufficiency. Platelet concenterates are subject to stress injury and modulation during collection, preparation and storage Potential side effects include alloimmunisation, thrombosis, sepsis, transfusion related acute lung injury. There remain limited studies examining the clinical impacts of platelet concentrate transfusion in critically ill patients [5].
To define transfusion practices regarding all components viz PC, FFP and PLTC among critically ill patients and to assess morbidity and mortality among adult transfused patients.
Type of study: The study was Hospital based observational descriptive study.
Study design: The study was longitudinal in design.
Place of study: The study was done conducted in ICU, IQ CITY Medical College and Hospital, Durgapur.
Period of study: The study was done for eighteen months after ethical clearance from March 2021 to September 2022.
Study population: The study was done on patients admitted in ICU of IQ CITY Medical College & Hospital, Durgapur and receiving one or more blood components i.e PRBC, FFP, PC.
Study setting: The study was conducted in ICU at IQ CITY Medical College and Hospital, Durgapur. IQ City Medical College and Narayana Multispecialty Hospital is a private medical college located in Durgapur. The number of beds in ICU is ten.
Sample size: Total 250 patients of more than 18 years age admitted in ICU and receiving blood component transfusion were selected as cases.
Inclusion criteria
Exclusion criteria
Statistical Analysis:
For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests, which compare the means of independent or unpaired samples, were used to assess differences between groups. Paired t-tests, which account for the correlation between paired observations, offer greater power than unpaired tests. Chi-square tests (χ² tests) were employed to evaluate hypotheses where the sampling distribution of the test statistic follows a chi-squared distribution under the null hypothesis; Pearson's chi-squared test is often referred to simply as the chi-squared test. For comparisons of unpaired proportions, either the chi-square test or Fisher’s exact test was used, depending on the context. To perform t-tests, the relevant formulae for test statistics, which either exactly follow or closely approximate a t-distribution under the null hypothesis, were applied, with specific degrees of freedom indicated for each test. P-values were determined from Student's t-distribution tables. A p-value ≤ 0.05 was considered statistically significant, leading to the rejection of the null hypothesis in favour of the alternative hypothesis.
Table 1: Association between Blood component: Mortality
MORTALITY |
|||
BLOOD COMPONENT |
No |
YES |
TOTAL |
PRBC |
167 |
44 |
211 |
Row % |
79.1 |
20.9 |
100 |
Col % |
85.6 |
80 |
84.4 |
PRBC+FFP |
3 |
1 |
4 |
Row % |
75 |
25 |
100 |
Col % |
1.5 |
1.8 |
1.6 |
PRBC+FFP+PC |
0 |
1 |
1 |
Row % |
0 |
100 |
100 |
Col % |
0 |
1.8 |
0.4 |
PRBC+PC |
5 |
0 |
5 |
Row % |
100 |
0 |
100 |
Col % |
2.6 |
0 |
2 |
FFP |
11 |
8 |
19 |
Row % |
57.9 |
42.1 |
100 |
Col % |
5.6 |
14.5 |
7.6 |
PC |
9 |
1 |
10 |
Row % |
90 |
10 |
100 |
Col % |
4.6 |
1.8 |
4 |
TOTAL |
195 |
55 |
250 |
Row % |
78 |
22 |
100 |
Col % |
100 |
100 |
100 |
Table 2: Distribution of Hb Group
Hb Group |
Frequency |
Percent |
<7 |
76 |
34.90% |
>7 |
142 |
65.10% |
Total |
218 |
100.00% |
Table 3: Distribution of INR Group
INR Group |
Frequency |
Percent |
≥1.5 |
25 |
92.60% |
<1.5 |
2 |
7.40% |
Total |
27 |
100.00% |
Figure 1: Distribution of MORTALITY
Out of 44 (80.0%) patients who died had received PRBC transfusion, 1 (1.8%) who died patient had received PRBC+FFP transfusion, 1 (1.8%) patient who died patient had CRBC+FFP+PC transfusion, 8 (14.5%) patients who died had FFP transfusion, and 1 (1.8%) patient who died had PC transfusion.
Association of BLOOD COMPONENT with Mortality was not statistically significant (p=0.0634) as shown in table 25 and figure 22.
In our study, 76 (34.9%) patients had ≤7 g/dl Hb and is assigned group 1 that is restrictive group and 142 (65.1%) patients had >7 g/dl Hb and were assigned group 2 that is liberal group as shown in table 8 and figure 6 .
In our study, 25 (92.6%) patients had ≥1.5 INR and were in restrictive Group and (7.4%) patients had <1.5 INR Group and were in liberal group as shown in table 11 and figure 9.
In our study, 55 (22.0%) patients died.
In the present study, the total number of patients was similar to studies done by mahambrey at al [6] and vlaar et al.[7] The mean age of patients was consistent with that of similar studies done.
The studies had included critically ill patients admitted to ICU. In the study done by Mahambrey et al [6] and Kasotakis et al [8] trauma patients admitted to ICU were included. Karam et al [9] included pediatric patients. In our study we included all critically patients admitted to ICU irrespective of diagnosis.
Our study was near to the study made by Zubrow et al [10] in terms of number of blood component transfused.
In study made by Makroo et al , [11] Herbert et al [12] more patients were in liberal group than restrictive group as seen in present study. In study made by Holst et al more patients were in restrictive group. So in our study guidelines for PRBC transfusion were followed in 35% patients.
The study made by Sanne de Buin was near to our study and considered 7g/dl as Hb threshold for PRBC transfusion. The study made by Estcourt et al [13] considered 7-9g/dl as Hb level for PRBC transfusion. The study made by Walsh et al and Holst et al randomized patients into two groups, restrictive group had haemoglobin threshold of 7g/l and liberal group had Hb level of 9g/dl while divided patients into restrictive group with Hb level of 7-9g/dl and liberal group with Hb level of 9-12 g/dl.
The study made by lauzier et al [14], considered INR level of 1.5 as threshold for FFP transfusion and was near to our study. In our study 25 patients were in restrictive group as compared to 2 people in liberal group. In study made 118 patients were in restrictive group as compared to 103 patients in liberal group. So guidelines for FFP transfusion were followed in more patients.
Our study was near to study by Lauralyn A Mcinttyre et al [15], holst et al [16]. Study by & there was not much difference in mortality among restrictive and liberal group. In our study mortality was more in restrictive group.
In study made by Lauralyn A Mcinttyre et al [15], Walsh et al [17] it was shown that there was no significant difference between average length of stay in restrictive and liberal group which is contradictory to our study. Our study was similar to study by Estcourt et al.[18] In our study there was significant difference between average length of stay in restrictive and liberal groups (0.0003).
We concluded that, while blood transfusions are indispensable in the ICU setting, the careful, evidence-based, and individualized approach to blood component utilization is vital. This will help optimize patient care, reduce potential risks, and ensure that blood products are used effectively and safely in critically ill patients. Further research and continuous monitoring of transfusion practices are essential to improve outcomes and reduce transfusion-related complications.