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Abstract
Background:
Anemia is highly prevalent among critically ill patients, and red cell concentrate (RCC) transfusion is frequently used in the intensive care unit, although the hemoglobin response remains variable. This study aimed to evaluate the influence of donor component characteristics and recipient clinical factors on hemoglobin increment following RCC transfusion in ICU patients at a resource-limited tertiary care hospital in Pakistan. This will provide context-specific evidence to optimize transfusion practices and improve patient blood management in critically ill populations.
Materials and Methods:
This prospective observational cohort study was conducted in an adult intensive care unit at Federal Government Polyclinic Hospital, Islamabad, from September 2024 to February 2025, enrolling 150 patients who received red cell concentrate (RCC) transfusion and had standardized pre- and post-transfusion hemoglobin measurements. Recipient clinical variables and donor/component characteristics were collected prospectively, and hemoglobin increment at 24 hours was analyzed using univariable and multivariable regression models. All data was entered and calculated using SPSS version 23.0. The statistical significance set at p ≤ 0.05.
Results:
Among 150 ICU patients receiving a single unit of red cell concentrate, the mean hemoglobin increment at 24 hours was 0.96 ± 0.42 g/dL, with substantial interpatient variability. Fresher blood (≤14 days), Rh-positive units, younger donor age, and absence of active bleeding were associated with significantly greater hemoglobin increments, while donor sex, sepsis, and vasopressor use were not. On multivariable analysis, active bleeding, higher pre-transfusion hemoglobin, increasing storage duration, donor age, and Rh status independently predicted hemoglobin response.
Conclusion:
Hemoglobin response to red cell concentrate transfusion in ICU patients is influenced by recipient and donor factors, including active bleeding, baseline hemoglobin, storage duration, donor age, and Rh status. Recognizing these determinants can optimize transfusion decisions and blood utilization, especially in resource-limited settings.