TRANSFUSION-RELATED COMPLICATIONS IN INTENSIVE CARE UNIT (ICU), RISK FACTORS, PREVENTION AND MANAGEMENT: A LITERATURE REVIEW

MI SHOAIB; MM ELMEISSERY

doi:10.54112/pjicm.v5i02.190

Authors

MI SHOAIB Consultant Critical Care Medicine, Rashid Hospital, Dubai Health, Dubai, UAE
MM ELMEISSERY Family Medicine, Ministry of Health & Population, Alexandria, Egypt

DOI:

https://doi.org/10.54112/pjicm.v5i02.190

Keywords:

Blood transfusion , Intensive Care Units, Massive transfusion, TRALI

Abstract

Background: Blood transfusion is a cornerstone of supportive therapy in intensive care units (ICUs), particularly among critically ill patients with anemia, trauma, sepsis, and massive hemorrhage. Despite strict blood safety protocols, transfusion-related complications remain a significant cause of morbidity and mortality in ICU settings. Objective: To comprehensively review transfusion-related complications in ICU patients, identify major risk factors, and summarize current strategies for prevention and management. Methods: A narrative literature review was conducted using PubMed, Embase, Web of Science, and Google Scholar. Original studies, systematic reviews, and review articles addressing transfusion-related complications in adult ICU populations were included. Data were synthesized to categorize complications, associated risk factors, pathophysiological mechanisms, and evidence-based management approaches. Results: Transfusion-related complications in the ICU include immunologic reactions such as acute and delayed hemolytic transfusion reactions, febrile non-hemolytic reactions, transfusion-related acute lung injury (TRALI), transfusion-associated graft-versus-host disease, post-transfusion purpura, and allergic or anaphylactic reactions. Non-immunologic complications include transfusion-associated circulatory overload, transfusion-transmitted infections, massive transfusion–related metabolic disturbances, and iron overload. Advanced age, female sex, comorbid cardiac or renal disease, positive fluid balance, massive or repeated transfusions, shock, smoking, and chronic alcohol use were consistently identified as key risk factors. Early recognition, immediate cessation of transfusion, supportive care, and preventive strategies such as leukoreduction, irradiation, restrictive transfusion strategies, and adherence to massive transfusion protocols significantly reduce adverse outcomes. Conclusion: Transfusion-related complications remain common and potentially life-threatening in critically ill patients. Improved awareness, early diagnosis, risk stratification, and implementation of preventive transfusion strategies are essential to enhance patient safety and optimize outcomes in ICU practice.

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