Effect of a Liberal Versus Restrictive Transfusion Strategy on Mortality in Patients With Moderate to Severe Head Injury

Abstract

We were unable to detect significant improvements in mortality with a liberal as compared to restrictive transfusion strategy in critically ill trauma victims with moderate to severe head injury.

Review article: Risks of anemia and related management strategies: can perioperative blood management improve patient safety?

“…As acknowledged, the values of Hb triggers differ amongst different patient populations. For example, patients with acute cardiac syndromes, 44 neurotrauma, 45 or comorbidities associated with advanced age may require higher Hb levels. 46 Interestingly, this perspective may be reflected in the progressive increase in both the Hb threshold for treatment and the average Hb in the restrictive arms of subsequent transfusion trials (Hb * 90 gÁL -1 ) (Fig.…”

The “sticky” business of “adherence” to transfusion guidelines

“…For red cell transfusions, there is good evidence from two randomized trials to guide the decision to transfuse in critically ill adult [6] and pediatric [7] patients. However, even this evidence suggesting that a red cell transfusion trigger of 70 g/L is appropriate (compared with 100 g/L) in stable nonbleeding patients may not be generalizable to other patient groups, especially those with cardiac disease or suffering from neurotrauma [8,9]. This is of particular importance as 46% of patients who received red blood cell (RBC) transfusions in the current review were bleeding [10].…”

Assessment and treatment of preoperative anemia: Continuing Professional Development

“…19,20 Indeed, the optimal Hb threshold may be even higher (100 gÁL -1 ) for patients suffering from neurotrauma or acute coronary syndromes. 21,22 The physiological response to anemia Acute anemia provides a primary ''hypoxic'' stimulus by decreasing blood oxygen content and reducing oxygen delivery to tissue. Tissue hypoxia is detected by specific ''hypoxic'' sensors at the cellular level.…”

“…19,20 En fait, le seuil de Hb optimal pourrait être encore plus élevé (100 gÁL -1 ) chez les patients atteints d'un traumatisme neurologique ou de syndromes coronariens aigus. 21,22 La réponse physiologique à l'anémie L'anémie aiguë fournit un stimulus 'hypoxique' primaire en réduisant le contenu d'oxygène dans le sang et l'apport d'oxygène aux tissus. L'hypoxie tissulaire est détectée par des capteurs 'hypoxiques' spécifiques au niveau cellulaire.…”