A prospective, randomized trial limiting perioperative red blood cell transfusions in vascular patients.
BACKGROUND
Patients undergoing major arterial reconstruction have traditionally been transfused with red blood cells to keep hemoglobin concentrations above 10 g/dL in order to prevent anemia-induced myocardial ischemia. There are no data to support this practice. The hypothesis that vascular patients will tolerate a hemoglobin concentration of 9 g/dL was examined.


METHODS
Ninety-nine patients undergoing elective aortic and infrainguinal arterial reconstructions were prospectively randomized preoperatively to receive transfusions to maintain a hemoglobin level of either 10 g/dL or 9 g/dL.


RESULTS
Despite significantly different postoperative hemoglobin levels of 11.0 +/- 1.2 versus 9.8 +/- 1.3 g/dL (P <0.0001), there were no differences in mortality or cardiac morbidity rates or length of hospital stay. There were no differences in hemodynamic parameters. Oxygen delivery was lower in the group with lower hemoglobin levels, but there was no difference in O2 consumption between the groups.


CONCLUSIONS
A lower hemoglobin concentration was tolerated without adverse clinical outcome. Patients did not compensate for anemia by increased myocardial work, but by increasing O2 extraction in the peripheral tissues.
Bush
R L
RL
Department of Surgery, University of California Davis Medical Center, Sacramento 95817, USA.
Pevec
W C
WC
Holcroft
J W
JW
D000368:Aged; D000704:Analysis of Variance; D001158:Arteries / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D006454:Hemoglobins