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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
- Source :
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 67:1576-1594
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
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.
- Subjects :
- medicine.medical_specialty
Blood management
Anemia
business.industry
General Medicine
Perioperative
030204 cardiovascular system & hematology
medicine.disease
3. Good health
law.invention
Clinical trial
03 medical and health sciences
0302 clinical medicine
Anesthesiology and Pain Medicine
Systematic review
Randomized controlled trial
030202 anesthesiology
law
Anesthesiology
Anesthesia
Acute care
medicine
Intensive care medicine
business
Subjects
Details
- ISSN :
- 14968975 and 0832610X
- Volume :
- 67
- Database :
- OpenAIRE
- Journal :
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Accession number :
- edsair.doi...........988e2d3fcdfa91fee667aa3b4cdb303d