Effects of blood transfusion on oxygen transport variables in severe sepsis

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

“…12,17,20,23,24 More importantly in animal and human studies of patients in shock, microvascular perfusion and oxygen consumption remains the same or decreases with RBC transfusion. 8,17,[25][26][27]59 The importance of the effect of RBC storage age on outcomes in critically ill patients is highlighted by the fact that the average age of transfused RBCs in the United States is 22 days 60 and multiple studies have indicated that the age of RBCs transfused is associated with increased morbidity and mortality in the critically ill. 18,22,61 The independent association of the amount of RBC transfusions with decreased survival may be related to the increased storage age of RBCs transfused to all patients in our study (33 days). The mean storage age of RBCs transfused per patient was not able to be analyzed as a variable associated with survival since this data were not recorded per patient.…”

“…10 -24 There is also a lack of evidence that the transfusion of stored RBCs improves oxygen consumption for patients with an oxygen debt or who are in shock. 17,20,[25][26][27] Current review articles describing damage control or hemostatic resuscitation principles, coupled with those describing the early coagulopathy of trauma, 28 -30 suggest a change from this classic approach maybe in order. Its goals for patients who are hypocoagulable or in shock with life threatening traumatic injuries are rapid surgical correction of large vessel bleeding, prevention and treatment of acidosis …”

Erythropoietin in Cancer Surgery

“…After volume resuscitation, increasing hemoglobin levels from 8.3 g/dL to 10.5 g/dL did not result in improvement of oxygen utilization or the "shock state" regardless of etiology. Similarly, in a study of septic patients, blood transfusion (hemoglobin 9.6 g/dL to 11.6 g/dL) did not affect oxygen uptake, despite significant increase in oxygen delivery 27 . These patients were known to have abnormal oxygen uptake by demonstrating increasing oxygen uptake in response to dobutamine.…”

Objectifs thérapeutiques

“…Correction d'une éventuelle anémie aiguë (17,18,19) Après correction du défi cit volémique et en l'absence de pathologie coronarienne avérée ou de syndrome hémorragique, transfuser des globules rouges lorsque l'hémoglobinémie est inférieure à 7 g/dl, l'objectif étant une hémoglo-binémie entre 7 et 9 g/dl (Grade 1B). …”