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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 11/2020

07.08.2020 | Review Article/Brief Review

When to transfuse your acute care patient? A narrative review of the risk of anemia and red blood cell transfusion based on clinical trial outcomes

verfasst von: Gregory M. T. Hare, MD, PhD, Melina P. Cazorla-Bak, BVSc, S. F. Michelle Ku, BMSc, Kyle Chin, BMSc, Nikhil Mistry, MSc, Michael C. Sklar, MD, Katerina Pavenski, MD, Ahmad Alli, MD, Adriaan Van Rensburg, MD, Jan O. Friedrich, MD, PhD, Andrew J. Baker, MD, C. David Mazer, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 11/2020

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Abstract

This narrative review critically evaluates the evidence for risk of anemia and red blood cell (RBC) transfusion. For this purpose, it assesses large prospective randomized-controlled trials (RCTs) in medical, surgical, and critical care patient populations in which the impact of specific hemoglobin transfusion thresholds are compared. In these trials, the risks of anemia relative to those of RBC transfusion are assessed. The results of published systematic reviews and meta-analyses are also discussed. Lastly, recommendations for patient blood management and treatment of anemia are explored. The main conclusion of this review emphasizes that the decision to transfuse RBCs is complex and depends on the interaction between multiple factors including the balance between the risk of anemia and the risk of RBC transfusion, existing patient comorbidities, and medical and surgical exposures. The transfusion thresholds recommended by current guidelines vary for medical and surgical patient populations. Guidelines suggesting specific transfusion thresholds for different patient populations should be viewed as a starting point for making an informed decision about RBC transfusion. Alternatives to transfusion (i.e., patient blood management), biomarkers of anemia-induced tissue hypoxia, and transfusion alternatives should continue to be evaluated in large RCTs, with the goal of improving event-free survival in critically ill and perioperative patients.
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Metadaten
Titel
When to transfuse your acute care patient? A narrative review of the risk of anemia and red blood cell transfusion based on clinical trial outcomes
verfasst von
Gregory M. T. Hare, MD, PhD
Melina P. Cazorla-Bak, BVSc
S. F. Michelle Ku, BMSc
Kyle Chin, BMSc
Nikhil Mistry, MSc
Michael C. Sklar, MD
Katerina Pavenski, MD
Ahmad Alli, MD
Adriaan Van Rensburg, MD
Jan O. Friedrich, MD, PhD
Andrew J. Baker, MD
C. David Mazer, MD
Publikationsdatum
07.08.2020
Verlag
Springer International Publishing
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 11/2020
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-020-01763-9

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