Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?

Abstract

A restrictive red blood cell transfusion strategy generally appears to be safe in most critically ill patients with cardiovascular disease, with the possible exception of patients with acute myocardial infarcts and unstable angina.

Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis

“…The decision to transfuse is complicated by several factors; severe anaemia and excessive blood loss are common in this setting 1,2 , and patients with cardiovascular disease have different transfusion requirements to other patient groups 3 . Transfusion decisions in cardiac surgery are most commonly based on the severity of perioperative anaemia: guidelines currently recommend (Grade C recommendation) highly restrictive transfusion thresholds with Haemoglobin (Hb) concentrations of 6-7g/dL 4,5 .…”

The “sticky” business of “adherence” to transfusion guidelines

“…For red cell transfusions, there is good evidence from two randomized trials to guide the decision to transfuse in critically ill adult [6] and pediatric [7] patients. However, even this evidence suggesting that a red cell transfusion trigger of 70 g/L is appropriate (compared with 100 g/L) in stable nonbleeding patients may not be generalizable to other patient groups, especially those with cardiac disease or suffering from neurotrauma [8,9]. This is of particular importance as 46% of patients who received red blood cell (RBC) transfusions in the current review were bleeding [10].…”

Assessment and treatment of preoperative anemia: Continuing Professional Development

“…19,20 Indeed, the optimal Hb threshold may be even higher (100 gÁL -1 ) for patients suffering from neurotrauma or acute coronary syndromes. 21,22 The physiological response to anemia Acute anemia provides a primary ''hypoxic'' stimulus by decreasing blood oxygen content and reducing oxygen delivery to tissue. Tissue hypoxia is detected by specific ''hypoxic'' sensors at the cellular level.…”

“…19,20 En fait, le seuil de Hb optimal pourrait être encore plus élevé (100 gÁL -1 ) chez les patients atteints d'un traumatisme neurologique ou de syndromes coronariens aigus. 21,22 La réponse physiologique à l'anémie L'anémie aiguë fournit un stimulus 'hypoxique' primaire en réduisant le contenu d'oxygène dans le sang et l'apport d'oxygène aux tissus. L'hypoxie tissulaire est détectée par des capteurs 'hypoxiques' spécifiques au niveau cellulaire.…”