Current perspectives and updates on transfusion strategies in critically ill anemic patients

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 optimal threshold 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 evidence-based and individualized transfusion decision-making in the ICU, aiming to optimize the balance between risks and benefits across diverse critical care settings.