In clinical practice, the decisition to transfuse is linked to the hope of

increasing oxygen transport (TO2) to tissues. If the sole purpose of

transfusion of red blood cells is to restore or maintain oxygen
delivery, then the saying oxygen is good and blood goes round and
round is the goal. However, just how should clinicians assess and
meet this goal? Despite it simplicity, the assessment of tissue
oxygenation remains one of the holy grails of medicine. (definisi
transfuse,macam-macam komponen transfusi)
Donated human blood (packed red blood cells) for transfusion is an
extraordinary, valuable, and lifesaving medical resource. The one
and only reason to provide a red blood cell transfusion to a human is
to restore or maintain the delivery of oxygen to vital organ systems.
Its use for any other reason has no physiologic or medical basis.
Although transfusion of blood can be lifesaving, it can also be
associated with a number of complications; some of which, such as
transmission of infection and allergic reactions, can be understood,
but others such as acute organ injury are unexpected and are only
now being researched.
The transfusion of erythrocyte products to correct anemia is one of
the least scientific practices to be encountered in the ICU. The World
Health Organization (WHO) defines anemia in men and women as a
haemoglobin (Hb) 130 and 120 g/l, respectively, and severe anemia
as 80 g/l. Anemia is highly prevalent among the critically ill. Studies
have shown that 77% of these patients present anemia during their
hospital stay, and more than one third of them end up receiving a
red blood cells transfusion. While WHO said that 60% of patient
admitted to intensive care unit (ICU) are anaemic and 20-30% have
a first haemoglobin concentration (Hb) 90 g/l. Anemia is secondary
to multiple factors. In addition to blood loss provoked by evident
bleedings, including iatrogenic anemia, which is caused by collection
of blood samples for exams, invasive procedures; nutrition failure;
hemolysis; occult blood loss; and endocrine, renal or hepatic system
alterations can also lead to a decrease in erythropoietin release,
which causes a decreases erythropoiesis, and the most important
initial contribution to anemia is critical care are hemodilition, blood
loss, and blood sampling.
Depending upon casemix, 30-50% ICU patients receive red cell
(RBC) transfusions. Ten percent of all RBCs transfused nationally are
given in general ICUs. Studies suggest that only 20% of transfusions
are to treat haemorrhage; the majority are given for anemia. Mean
blood consumption ranges from 2 to 4 units per admission. Two
studies assessed the incidence of anemia and the use fo blood
transfusion in Europe and the United States. The European study
has shown a transfusion rate of 37% during the ICU stay, whereas
the American study shows that about 44% of ICU patients
underwent transfusion. The mean pretransfusion hemoglobin (Hb)

values were 8,4 g/dL and 8,6 g/dL, respectively. However, both
studies show that transfusion was associated with a worse
prognosis. The Transfusion Requirements In Critical Care (TRICC)
study recommendations a guiding transfusion policy in adult
critically ill patients which are : a transfusion threshold of 70 g/l or
below, with a target Hb range of 70-90 g/l, should be default for all
critically ill patients, unless specific co-morbidities or acute illness
related factors modify clinical decision-making. Transfusion triggers
shoud not exceed 90 g/l in most critically ill patients.
(but clinical practice guideline on elective._)
However, determinants of exactly which patients to transfuse
remain poorly defined and have been the subject of considerable
debate in recent years.
(physicologic transfusion triggers.)