Importance of assessing biomarkers and physiological parameters of anemia-induced tissue hypoxia in the perioperative period

Chin, Kyle; Joo, H.S.; Jiang, Helen; Lin, Chloe; Savinova, Iryna; Joo, Sarah; Alli, Ahmad; Sklar, Michael C.; Papa, Fábio de Vasconcelos; Simpson, Jeremy A.; Baker, Andrew J.; Mazer, C. David; Darrah, William Culp; Hare, Gregory M. T.

doi:10.1016/j.bjane.2022.10.004

Cited by 5 publications

(1 citation statement)

References 94 publications

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“…The biological implications for hemoglobin concentrations used for defining transfusion thresholds are unclear. Surrogates for measuring the adequacy of the balance of oxygen delivery and consumption may provide greater insight on the degree of anemic stress faced by a patient [24]. These markers may better inform and personalize transfusion therapy for avoiding unnecessary transfusion, and administering necessary transfusion, as opposed to utilizing hemoglobin triggers alone.…”

Section: Future Directions and Unanswered Questionsmentioning

confidence: 99%

Transfusion thresholds in acute coronary syndromes

Mistry,

Jiang,

Chin

et al. 2023

Current Opinion in Cardiology

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Purpose of review Anemia is prevalent in patients with acute coronary syndromes. In this setting, there is uncertainty and controversy surrounding the optimal transfusion strategy for managing anemia. The goal of this review is to summarize the current clinical evidence, guidelines, and future directions for managing transfusion in acute coronary syndromes. Recent findings There is limited evidence from randomized trials evaluating restrictive versus liberal transfusion in patients hospitalized with and/or for acute coronary syndromes. The results from these studies suggest clinical equipoise between transfusion strategies for short term outcomes, and a trend toward favoring a liberal strategy for long term major adverse cardiac events. There is inconsistency across clinical practice guidelines with respect to the optimal strategy for managing anemia and transfusion in acute coronary syndromes due to insufficient evidence. Summary More evidence is urgently needed to conclusively establish the optimal strategy for transfusion management in the setting of acute coronary syndromes. These data will directly inform harmonization of clinical practice guidelines. Future investigations should explore alternative strategies to hemoglobin for quantifying the degree of anemic stress for personalizing transfusion therapy, the effects on functional outcomes, and managing anemia following hospital discharge.

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Section: Future Directions and Unanswered Questionsmentioning

confidence: 99%

Transfusion thresholds in acute coronary syndromes

Mistry,

Jiang,

Chin

et al. 2023

Current Opinion in Cardiology

View full text Add to dashboard Cite

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An overview of circulating and urinary biomarkers capable of predicting the transition of acute kidney injury to chronic kidney disease

Berezin,

Berezina,

Hoppe

et al. 2024

Expert Review of Molecular Diagnostics

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Bilateral nephrectomy impairs cardiovascular function and cerebral perfusion in a rat model of acute hemodilutional anemia

Chin,

Jiang,

Steinberg

et al. 2024

Journal of Applied Physiology

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Anemia and renal failure are independent risk factors for perioperative stroke, prompting us to assess the combined impact of acute hemodilutional anemia and bilateral nephrectomy (2Nx) on microvascular brain pO2 (PBrO2) in a rat model. Changes in PBrO2 (phosphorescence quenching) and cardiac output (CO, echocardiography) were measured in 2 different groups of anesthetized Sprague-Dawley rats (1.5% isoflurane, n = 5-8 per group) randomized to Sham 2Nx or 2Nx and subsequently exposed to acute hemodilutional anemia (50% estimated blood volume exchange with 6% hydroxyethyl starch) or time based controls (no hemodilution). Outcomes were assessed by ANOVA with significance assigned at p<0.05. At baseline, 2Nx rats demonstrated reduced CO (49.9±9.4 vs. 66.3±19.3 mL/min) and PBrO2 (21.1±2.9 vs. 32.4±3.1 mmHg) relative to Sham 2Nx rats (p<0.05 for both). Following hemodilution 2Nx rats demonstrated a further decrease in PBrO2 (15.0±6.3 mmHg, p<0.05). Hemodiluted 2Nx rats did not demonstrate a comparable increase in CO (74.8±22.4 vs 108.9±18.8 mL/min, p<0.001) after hemodilution which likely contributed to the observed reduction in PBrO2. This impaired CO response was associated with reduced fractional shortening (33±9 vs. 51±5 %) and increased left ventricular end systolic volume (156±51 vs 72±15 µL, p<0.001) suggestive of systolic dysfunction. By contrast, hemodiluted Sham 2Nx animals demonstrated a robust increase in CO and preserved PBrO2. These data support the hypothesis that the kidney plays a central role in maintaining cerebral perfusion and in initiating the adaptive increase in CO required to optimize PBrO2 during acute anemia.

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Importance of assessing biomarkers and physiological parameters of anemia-induced tissue hypoxia in the perioperative period

Cited by 5 publications

References 94 publications

Transfusion thresholds in acute coronary syndromes

Transfusion thresholds in acute coronary syndromes

An overview of circulating and urinary biomarkers capable of predicting the transition of acute kidney injury to chronic kidney disease

Bilateral nephrectomy impairs cardiovascular function and cerebral perfusion in a rat model of acute hemodilutional anemia

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