Topic
Haematology in critical care
Transfusion, anticoagulation, and thrombocytopenia in the ICU.
What the evidence shows
Transfuse at 7 g/dL. A restrictive threshold was at least as effective as a liberal one in critically ill patients, and possibly better in the young and less acutely ill (TRICC). The authors' own exception — myocardial infarction and unstable angina — has kept researchers busy for twenty-five years and remains unresolved.
In acute chest syndrome, therapeutic-dose anticoagulation shortened the episode from 6.1 to 4.8 days and nearly halved opioid requirement, without major bleeding in either arm (TASC). With 101 patients, a bleeding risk cannot be excluded.
Anticoagulation in acute chest syndrome
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| TASC | 2025 | Therapeutic-dose anticoagulation | Therapeutic-dose anticoagulation shortened acute chest syndrome and nearly halved opioid use without causing bleeding |
Transfusion threshold in critical illness
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| TRICC | 1999 | Restrictive transfusion strategy | Transfusing at 7 rather than 10 g/dL was at least as good, and possibly better |
Key references
Guidelines, standards and reviews for this topic.
- Hematologic emergencies
- Lafarge A, Chean D, Whiting L, et al. Management of hematological patients requiring emergency chemotherapy in the intensive care unit. Intensive Care Med 2024 Jun;50(6):849-860. PMID 38748265
- Sickle Cell Anemia
- Novelli EM, Gladwin MT. Crises in Sickle Cell Disease. Chest 2016 Apr;149(4):1082-93. PMID 26836899
- Transfusion
- Coz Yataco AO, Soghier I, Hébert PC, et al. Red Blood Cell Transfusion in Critically Ill Adults: An American College of Chest Physicians Clinical Practice Guideline. Chest 2025 Feb;167(2):477-489. PMID 39341492
- Coz Yataco A, Soghier I, Hébert PC, et al. Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults: An American College of Chest Physicians Clinical Practice Guideline. Chest 2025 Sep;168(3):661-676. PMID 40074060