The Limits of Acute Anemia

Abstract

For many years, physicians’ approach to the transfusion of allogeneic red blood cells (RBC) was not individualized. It was accepted that a hemoglobin concentration (Hb) of less than 10 g/dL was a general transfusion threshold and the majority of patients were transfused immediately. In recent years, there has been increasing evidence that even significantly lower hemoglobin concentrations can be survived in the short term without sequelae. This somehow contradicts the observation that moderate or mild anemia is associated with relevant long-term morbidity and mortality. To resolve this apparent contradiction, it must be recognized that we have to avoid acute anemia or treat it by alternative methods. The aim of this article is to describe the physiological limits of acute anemia, match these considerations with clinical realities, and then present “patient blood management” (PBM) as the therapeutic concept that can prevent both anemia and unnecessary transfusion of RBC concentrates in a clinical context, especially in Intensive Care Units (ICU). This treatment concept may prove to be the key to high-quality patient care in the ICU setting in the future.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management

“…Ultimately, these findings underscore the importance of a personalized, patient-centered approach to transfusion medicine, in which the focus shifts from Hb concentrations alone to a more comprehensive assessment of the patient's overall clinical status. 18 …”

“…Instead, the overall goal is to proactively prevent any form of anemia as far as possible. 18

Figure 1 The pillars of Patient Blood Management (PBM).

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Patient Blood Management after Hematopoietic Stem Cell Transplantation in a Pediatric Setting: Starting Low and Going Lower

“…In order to optimize the transfusion strategy, during the last decades several studies have been conducted in many different medical fields (i.e., surgery) introducing the concept of patient blood management (PBM) [ 6 ]. PBM is a multidisciplinary evidence-based concept aimed at optimizing patient hemoglobin (Hb) concentration, minimizing blood loss, and improving hemostasis to increase patient safety [ 7 ]. To date, many studies have been conducted so far to implement PBM in different adult contexts; conversely, few studies are available in pediatric settings [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”