Clinical consequences of anemia and red cell transfusion in the critically ill

University of Ottawa, Ottawa, Ontario, Canada
Critical Care Clinics (Impact Factor: 2.16). 05/2004; 20(2):225-35. DOI: 10.1016/j.ccc.2003.12.006
Source: PubMed


Despite the frequent use of red cell transfusions, only one large randomized trial has examined red cell administration perioperative and in the critical care setting. However, the TRICC Trial does not provide sufficient evidence to determine optimal transfusion practice in postoperative care, in critically ill children, or in patients with a myocardial infarction or acute coronary syndromes. In addition, most transfusion practice guidelines published before the completion of the TRICC Trial are now dated and need to have expert opinion informed by solid evidence in diverse clinical settings. In the next several years,several randomized trials will provide additional evidence in support of bedside decision-making. For example, two transfusion studies will be evaluating transfusion triggers, including one in premature infants and the other in critically ill children. At this juncture, high-quality clinical evidence is not yet available for many decisions related to red cell transfusions. We anticipate that risks and benefits of red cells and alternatives will be elucidated in the coming years.

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    • "Les bénéfices immédiats de la transfusion sanguine sont liés à la capacité des globules rouges d'augmenter l'apport d'oxygène aux tissus afin de réduire les risques liés à l'anémie. Risques et bénéfices liés à l'anémie et à la transfusion sanguine ne sont donc pas équivalents, et faire la part des choses entre ces différents éléments semble impossible en dehors d'une étude prospective randomisée [1]. Au cours de ces dernières années, de nombreux guides de bonne pratique ont été publiés, définissant une gâchette transfusionnelle à partir d'une valeur seuil d'hémoglobine ou d'hématocrite. "

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    ABSTRACT: Surgical blood loss and trauma are the major causes of allogeneic blood transfusions, which still bear considerable risks. After the correction of hypovolemia, the anesthesiologist often has to deal with normovolemic anemia. The clinical relevance of this isolated decrease in hemoglobin concentration consists in an eventually compromised global or regional oxygen supply with the development of tissue hypoxia below a critical threshold. This is an individual threshold for each patient and depends on his or her capacity to compensate the decrease in blood oxygen content. Therefore, physiologic transfusion triggers should primarily be applied and not rigid numeric transfusion triggers, such as hemoglobin concentration, which do not take into account each patient's individual reserve.
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