REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Current perspectives and updates on transfusion strategies in critically ill anemic patients
Hongli He 1
Haowei Yang 2
Feifei Li 2
Zhenghua Zhu 3
Lining Si 4
Yi Liu 3
Songbei Li 5
Yang Liu 6
Hua Cai 6
Yuxin Fan 7
Yuxuan Zhang 7
Chun Pan 6
Sen Lu 6
1. Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
2. University of Electronic Science and Technology of China, Chengdu, China
3. The Second People's Hospital of Kunming, Kunming, China
4. Qinghai University Affiliated Hospital, Xining, China
5. Affiliated Hospital of Chengdu University, Chengdu, China
6. Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, China
7. Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Abstract
【Abstract】 Anemia is a frequently encountered condition in critically ill patients, and red blood cell transfusion serves as a critical therapeutic intervention aimed at restoring hemoglobin levels and improving tissue oxygenation. However, the optimalthreshold for transfusion remains a subject of controversy, particularly regarding the comparison between restrictive (Hb 7–9 g/dL) and liberal (Hb >9 g/dL) strategies However, we should also consider a third option. This method focuses on the individual patient. Doctors adjust care based on the patient's specific symptoms and other health problems. The selection of the appropriate strategy is contingent upon specific clinical conditions, such as sepsis, acute coronary syndrome, or neurological injury. Current evidence and clinical guidelines predominantly favor a restrictive transfusion in hemodynamically stable patients, whereas a liberal strategy may benefit those with underlying cardiovascular disease. This review synthesizes recent trial data and guideline recommendations to facilitate but also the consideration of a third approach: individualized titrated care based on clinical symptoms and comorbidities. 删除[Author]: . 删除[Administrator]: evidence-based and individualized transfusion decision-making in the ICU, aiming to optimize the balance between risks and benefits across diverse critical care settings.
Summary
Keywords
Blood Transfusion, Intensive Care Units, liberal transfusion, Restrictive transfusion, Transfusion threshold
Received
07 December 2025
Accepted
18 February 2026
Copyright
© 2026 He, Yang, Li, Zhu, Si, Liu, Li, Liu, Cai, Fan, Zhang, Pan and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hongli He
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.