Transfusion trigger: when to transfuse?
The decision to transfuse a hospitalized patient must balance the known risks of transfusion with the need to provide adequate tissue oxygenation and the appropriate utilization of blood as a scarce resource. The minimum tolerated hemoglobin level is not well established, and considerable variation exists in intensivists' transfusion practices. Conventional transfusion triggers of 100 g/l have been challenged by reports indicating that aerobic metabolism is supported by hemoglobin levels of 50 g/l or less. Evidence from randomized trials also indicates that withholding transfusions may result in improved outcomes. Arbitrary numeric hemoglobin triggers, however, cannot supercede intervention based on individual physiologic need and clinical circumstances.
Marshall
John C
JC
University of Toronto, Toronto, Ontario, Canada. john.marshall@uhn.on.ca
D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000145:classification* / Q000628:therapy*; D006801:Humans; D065227:Transfusion Reaction