Transfusion Practice and Red Blood Cell Use in Patients in Critical Condition: Effects on Survival

Abstract

Objective: Transfusion decisions critically influence outcomes in severe illness. Patient Blood Management (PBM) strategies optimize transfusion practice and mitigate immunological risk. Materials and Methods: This retrospective study reviewed 30-month transfusion records across all departments. Transfusion endpoints—including red blood cell (RBC), platelet , and fresh frozen plasma—were evaluated. RBC recipients were stratified into critical-risk units versus other clinical departments. Outcomes were defined by survival status during follow-up. Analyses comprised Kaplan–Meier survival curves, logistic regression (univariate and multivariate), and ROC curve evaluation. Results: Among 1,805 patients receiving 4,999 RBC transfusions, 208 were analyzed (Oct–Dec 2023; median follow-up 12.45 months). Of these, 42.3% were transfused in critical-risk departments and 43.3% died. Survivors showed higher pre- and post-transfusion RBC and lymphocyte counts (p < 0.05). Mortality was independently associated with transfusion intensity, malignancy, and critical care admission. Multivariate analysis confirmed age, malignancy, and critical care admission as predictors of poor survival. ROC analysis indicated strong model performance (AUC = 0.859), and Kaplan–Meier curves revealed significantly reduced survival in high-risk subgroups. Conclusion: Transfusion burden and immune parameters shape survival in critical illness, underscoring individualized, risk-adapted PBM. Key words: Transfusion Practice, Red Blood Cell, Critical Risk Units , Survival