Controversies related to red blood cell transfusion in critically ill patients

Abstract

RBC transfusion is unequivocally indicated for treatment of anemic hypoxia. However, critical hemoglobin or Hct below which all critically ill patients require transfusion has not been established and there are inherent risks associated with allogenic blood transfusion. Clinical trials designed to evaluate the effects of RBC age and leukoreduction on veterinary patient outcome are warranted. Implementation of evidence-based transfusion guidelines and consideration of alternatives to allogenic blood transfusion are advisable.

Influence of cross‐match on posttransfusion packed cell volume in feline packed red blood cell transfusion

“…The immunosuppressive consequences of RBC transfusion have been recognized in human clinical medicine for many decades, and descriptions of this phenomenon have been published in both human and veterinary literature. 22,23 While transfusion-associated immune modulation has not been related to a prolonged survival of transfused RBCs, this could explain the reduced clearance of transfused RBC in some cats in this study, particularly those receiving multiple transfusions in the CM+ group. Further investigation into this phenomenon is warranted.…”

Risk factors for transfusion-associated complications and nonsurvival in dogs receiving packed red blood cell transfusions: 211 cases (2008–2011)

“…Likewise, multivariate analysis revealed that the dose (mL/kg) of other blood products transfused was a risk factor for transfusion-associated complications. Although transfusion-related ALI has been reviewed in the veterinary literature 33 and massive transfusion is considered a risk factor for ALI, 26 there are no published case reports of transfusion-related ALI in veterinary patients, to our knowledge. 28 Most of the recent human literature investigating transfusion-associated complications is focused on the incidence and pathogenesis of ALI, specifically transfusion-related ALI that occurs within 6 hours after a transfusion.…”

Gatilhos para transfusão sanguínea

“…As mais comuns são a reação não hemolítica febril ou hipertermia, a reação alérgica, a contaminação bacteriana e a lesão pulmonar aguda (TRALI), conforme revisado por Pincelli et al (2010). A TRALI é caracterizada por um edema pulmonar agudo não cardiogênico que pode ocorrer após a transfusão de hemácia, levando a uma grave dispneia e hipoxemia e eventualmente pode ocorrer febre, hipotensão e cianose (PRITTIE, 2010). É a principal causa de mortalidade em seres humanos relacionada à transfusão (TOCCI, 2010), em animais, a TRALI foi relatada apenas em modelos experimentais (PRITTIE, 2010).…”

“…Existe atualmente um debate sobre os principais critérios para a indicação de uma transfusão sanguínea tanto em humanos como em animais, uma vez que, dependendo da causa da anemia e da quantidade e rapidez do sangue perdido, a anemia pode ser bem tolerada (PRITTIE, 2010).…”

“…Atualmente em humanos, muitos autores têm recomendado transfusão de concentrado de hemácias (CH) em pacientes criticamente enfermos, com concentração de hemoglobina inferior a 7,0 g/dL, evitando transfusões com valores de hemoglobina superiores a 10,0 g/dL (MCFARLAND, 1999;VINCENT;YALAVATTI, 2003;NAPOLITANO;CORWIN, 2004;FERREIRA;FERREIRA;PELANDRÉ, 2005;SIGRIST, 2008;PRITTIE, 2010;WANG;KLEIN, 2010, SAKR et al, 2010. Hébert et al (1999), avaliaram um total de 838 pacientes críticos admitidos na unidade de terapia intensiva com hemoglobina inicial de 9 g/dL.…”