An evidence-based approach to red blood cell transfusions in asymptomatically anaemic patients

Abstract

INTRODUCTION Surgeons and physicians encounter blood transfusions on a daily basis but a robust evidence-based strategy on indications and timing of transfusion in asymptomatic anaemic patients is yet to be determined. For judicious use of blood products, the risks inherent to packed red blood cells, the patient's co-morbidities and haemoglobin (Hb)/haematocrit levels should be considered. This review critiques and summarises the latest available evidence on the indications for transfusions in healthy and cardiac disease patients as well as the timing of transfusions relative to surgery. METHODS An electronic literature search of the MEDLINE ® , Google Scholar™ and Trip databases was conducted for articles published in English between January 2006 and January 2015. Studies discussing timing and indications of transfusion in medical and surgical patients were retrieved. Bibliographies of studies were checked for other pertinent articles that were missed by the initial search. FINDINGS Six level 1 studies (randomised controlled trials or systematic reviews) and six professional society guidelines were included in this review. In healthy patients without cardiac disease, a restrictive transfusion trigger of Hb 70-80g/l is safe and appropriate whereas in cardiac patients, the trigger is Hb 80-100g/l. The literature on timing of transfusions relative to surgery is limited. For the studies available, preoperative transfusions were associated with a decreased incidence of subsequent transfusions and timing of transfusions did not affect the rates of colorectal cancer recurrence.

Perioperative Aspirin Use Is Associated with Bleeding Complications during Robotic Partial Nephrectomy

“…A study by Chan and de Gara describes transfusion trigger recommendations in either symptomatic or asymptomatic postoperative patients; transfusions are recommended in asymptomatic patients with pre-existing cardiovascular disease who meet a particular transfusion trigger threshold. 19 Of note, threshold to transfuse was not standardized amongst the institutions in our study. We also found pASA use associated with increased overall complication rates, both major and minor.…”

Routine Type and Screens Are Unnecessary in Primary Total Joint Arthroplasty: Follow-up After a Change in Practice

“…All patients receive a standard 2-g dose of TXA perioperatively in addition to weight-based dosing of local periarticular injection containing ropivacaine, epinephrine, and ketorolac [ 21 ]. Blood products are given in accordance with evidence-based hemoglobin thresholds of 7 g/dL and 8 g/dL for patients with a cardiovascular disease [ 22 , 23 ].…”

Bleeding complication after surgical removal of impacted teeth in a patient with undiagnosed clotting disorder

“…After the blood exams, haematocrit and haemoglobin were lower than reference values indicating erythrocytes loss caused by bleeding episodes. Chan & Gara [17] and Carson et al [18] highlighted importance of blood transfusion when hemoglobin and hematocrit were respectively lower than 7.0g/dl and 30% in exam findings, but red blood cells transfusions can be carried out in cases of hemoglobin values from 7.0 up to 10.0g/dl and acute bleedings. Although the patient has been in a situation of flexible practice of blood transfusion according to these authors, red blood cells transfusions were performed to control its volume and maintain his oxygenation.…”