Hemodilution and anemia in patients with cardiac disease: what is the safe limit?

Tircoveanu, Robert; Linden, Philippe Van der

doi:10.1097/aco.0b013e3282f35ebf

Cited by 14 publications

(7 citation statements)

References 42 publications

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“…It is established that during acute myocardial ischemia, myocardial injury becomes worse by concomitant anemia 3 and there is a resultant worsening of such patients’ prognosis. 4 Nevertheless, it is unknown what should be the absolute threshold for giving blood transfusions to patients suffering from chronic ischemic heart disease (IHD) and anemia 5 nor it is known what should be the threshold for administrating blood transfusions for patients with acute coronary syndromes (ACSs). 6 Moreover, it was shown that restrictive blood transfusion strategies, limiting such treatment, in a population of critically ill patients (including patients suffering from cardiac events) to levels of hemoglobin which were lower than 7 g/L had better clinical results.…”

Section: Introductionmentioning

confidence: 99%

Avoidance of Blood Transfusion to Patients Suffering From Myocardial Injury and Severe Anemia Is Associated With Increased Long-Term Mortality

et al. 2015

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Myocardial injury and anemia are common among patients in internal medicine departments. Nevertheless, the level of anemia in which blood should be given to these patients is ill defined.We conducted a retrospective, cohort analysis.A total of 209 patients hospitalized to internal medicine, with myocardial injury (troponin I > 0.2 mcg/L, not diagnosed as ACS, acute coronary syndrome) and anemia (Hb < 10 g/dL, without overt bleeding) were included. The overall in-hospital mortality rate was 20.7%. A total of 37 patients (17.8%) had severe anemia (Hb < 8 g/dL). A total of 73 patients (34.9%) were transfused. Severe anemia was not associated with increased long-term mortality in the whole cohort while survival of patients with severe anemia that were not transfused was significantly reduced compared to transfused patients (44% vs 80%; P = 0.03). Mortality rates were similar for all patients with Hb ≥ 8 g/dL, regardless of transfusion (54% vs 49%; P = 0.60). Consistently, lack of blood transfusion in patients with severe anemia was independently associated with a 2.27 (1.08–4.81) greater adjusted risk of all-cause mortality (P-value for interaction = 0.04), whereas it did not significantly increase in patients with Hb ≥ 8 g/dL.Avoidance of blood transfusion is associated with unfavorable outcomes among patients with myocardial injury and severe anemia.

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Section: Introductionmentioning

confidence: 99%

Avoidance of Blood Transfusion to Patients Suffering From Myocardial Injury and Severe Anemia Is Associated With Increased Long-Term Mortality

et al. 2015

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“…In conscious humans it has been shown that the increase in cardiac output and in the oxygen extraction rate has successfully preserved the adequate supply of tissue oxygen until Hb reaches 5.0 g/dL . Extraction rates of oxygen vary for different organs and systems; therefore, it cannot be substantiated that a global measure like oxygen delivery would reflect upon the necessity and adequacy of perfusion . Some related cases of patients who survived levels of Hb below 2.0 g/dL are clinical proof of this fact .…”

Section: Discussionmentioning

confidence: 99%

Postoperative management of severe acute anemia in a Jehovah's Witness

2013

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“…These two studies identified Hb levels as low as 5-6 g/dl to be relevant, indicating commonly used triggers like 10 g/dl might not be necessary to provide sufficient oxygen supply. Notably, a recent review article by Tircoveanu and Van der Linden [50 ] could not establish 'the minimal' threshold for anemia in patients with cardiac disease and recommended that, rather than primarily focusing on transfusion, physicians should first administer therapies that have been shown to improve outcome, such as control of heart rate.…”

Section: Transfusion Triggersmentioning

confidence: 98%