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(Chest. 2005;127:295-307.)
© 2005 American College of Chest Physicians

Anemia, Allogenic Blood Transfusion, and Immunomodulation in the Critically Ill*

Murugan Raghavan, MD and Paul E. Marik, MD, FCCP

* From the Department of Critical Care Medicine (Dr. Raghavan), University of Pittsburgh Medical Center, Pittsburgh; and Division of Pulmonary and Critical Care Medicine (Dr. Marik), Thomas Jefferson University, Philadelphia, PA.

Correspondence to: Paul Marik, MD, FCCP, Chief, Pulmonary and Critical Care Medicine, 1015 Chestnut St, Suite M100, Philadelphia, PA 19107; e-mail: paul.marik{at}jefferson.edu

Anemia and allogenic RBC transfusions are exceedingly common among critically ill patients. Multiple pathologic mechanisms contribute to the genesis of anemia in these patients. Emerging risks associated with allogenic RBC transfusions including the transmission of newer infectious agents and immune modulation predisposing the patient to infections requires reevaluation of current transfusion strategies. Recent data have suggested that a restrictive transfusion practice is associated with reduced morbidity and mortality during critical illness, with the possible exception of acute coronary syndromes. In this article, we review the immune-modulatory role of allogenic RBC transfusions in critically ill patients.

Key Words: blood transfusion • critically ill • ICU • immune modulation • infections • microchimerism • nosocomial infection




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