Should We Reconsider Recommendations for Red Blood Cell Transfusion?

Hardy, Jean‐François; Bélisle, Sylvain

doi:10.1111/j.1778-428x.2003.tb00172.x

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…(11,(22)(23)(24) Hemoglobin levels were actually used as a trigger variable for the indication of transfusions for years, however the optimal hemoglobin levels vary considerably from one patient to another depending on multiple variables such as age, chronic diseases (especially coronary artery disease), current diagnosis, cause of anemia and anemia tolerance. (15,25,26) There are studies that clearly demonstrate the good tolerability that some patients with low hemoglobin levels have of anemia and the effectiveness of blood conservation strategies and autologous red blood cell production stimulating procedures, which maximize the final hematocrit without RBCT. (27,28) Another aspect to consider is that in gastrointestinal procedures, blood loss can be greatly minimized through minimally invasive surgical techniques, reduced surgical time and surgical planning with the conservation of the patient's blood by avoiding iatrogenic hemorrhages.…”

Section: Discussionmentioning

confidence: 99%

Fatores preditivos da transfusão de concentrado de hemácias em pacientes submetidos a cirurgias eletivas do aparelho digestivo: uma análise interinstitucional

Jorge

Silva

Júnior

et al. 2010

Rev. Bras. Hematol. Hemoter.

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Section: Discussionmentioning

confidence: 99%

Fatores preditivos da transfusão de concentrado de hemácias em pacientes submetidos a cirurgias eletivas do aparelho digestivo: uma análise interinstitucional

Jorge

Silva

Júnior

et al. 2010

Rev. Bras. Hematol. Hemoter.

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“…[31–34] The decision to perform RBC transfusion should be made on both clinical and haematological grounds. Transfusion is rarely indicated in the stable patient when Hb is > 10 gm/dL and is almost always indicated when < 6 gm/dL.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

Anaemia and pregnancy: Anaesthetic implications

Grewal¹

2010

Indian J Anaesth

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Anaemia in pregnancy defined as haemoglobin (Hb) level of < 10 gm/dL, is a qualitative or quantitative deficiency of Hb or red blood cells in circulation resulting in reduced oxygen (O2)- carrying capacity of the blood. Compensatory mechanisms in the form of increase in cardiac output (CO), PaO2, 2,3 diphosphoglycerate levels, rightward shift in the oxygen dissociation curve (ODC), decrease in blood viscosity and release of renal erythropoietin, get activated to variable degrees to maintain tissue oxygenation and offset the decreases in arterial O2 content. Parturients with concomitant medical diseases or those with acute ongoing blood losses may get decompensated, leading to serious consequences like right heart failure, angina or tissue hypoxemia in severe anaemia. Preoperative evaluation is aimed at assessing the severity and cause of anaemia. The concept of an acceptable Hb level varies with the underlying medical condition, extent of physiological compensation, the threat of bleeding and ongoing blood losses. The main anaesthetic considerations are to minimize factors interfering with O2 delivery, prevent any increase in oxygen consumption and to optimize the partial pressure of O2 in the arterial blood. Both general anaesthesia and regional anaesthesia can be employed judiciously. Monitoring should focus mainly on the adequacy of perfusion and oxygenation of vital organs. Hypoxia, hyperventilation, hypothermia, acidosis and other conditions that shift the ODC to left should be avoided. Any decrease in CO should be averted and aggressively treated.

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“…There must be a conservative approach to restrictive triggers in unstable situations. Some authors allude to this as a tailored approach to transfusion 23 …”

Section: Indications In the Critically Illmentioning

confidence: 99%

The benefits of allogeneic erythrocyte transfusion: what evidence do we have?

Soni

Thomas

2008

Transfus Alt Transfus Med

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SUMMARY Restrictive blood transfusion practice has modified the indications for blood transfusion. There is still a need for succinct definition of transfusion thresholds in different situations, based on physiological argument balancing the mechanisms by which blood is potentially beneficial against the deleterious effects of transfusion, whether known, speculative or unknown. The latter still need identification. The key physiological benefit is through oxygen delivery and thereby the provision of a margin of safety in tissue oxygenation. This can be achieved by a range of methods that safeguard blood volume, conserve blood or increase hemoglobin as well as by transfusion, and in many situations conservation methods can or could now preclude transfusion. There are still acute and less controlled or controllable situations where conservation methods are difficult to implement or may need to be complemented by transfusion. These are the indications that still need clarification. Difficult and confusing areas of practice include the management of patients with ischemic heart disease. This is a potential driver for transfusion to prevent ischemia, but clarity of efficacy or detriment is elusive beyond acknowledging that both too high and too low hemoglobin values are detrimental. The issue in all clinical situations, whether acute or chronic, is to continue to reevaluate the safety of current thresholds. This will help limit blood usage and ensure that blood is used when necessary but not otherwise.

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Should We Reconsider Recommendations for Red Blood Cell Transfusion?

Cited by 5 publications

References 30 publications

Fatores preditivos da transfusão de concentrado de hemácias em pacientes submetidos a cirurgias eletivas do aparelho digestivo: uma análise interinstitucional

Fatores preditivos da transfusão de concentrado de hemácias em pacientes submetidos a cirurgias eletivas do aparelho digestivo: uma análise interinstitucional

Anaemia and pregnancy: Anaesthetic implications

The benefits of allogeneic erythrocyte transfusion: what evidence do we have?

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