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Old 04-03-2011
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Blood Indications of packed red blood cell transfusion (PRBC)

When should we proceed with PRBC transfusion in patients with coronary heart disease and in healthy patients without such disease?

From what I've read, a hemoglobin value of less than 10 or less than 8 in CHD-patients and healthy patients, respectively, is one indication.

What about the hematocrit cut-off value?

And is there other indications?

Thank you.
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Old 04-03-2011
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Hi Haisook,

While the numbers you suggested are okay for broad guidelines (actually I've even seen 7 for "healthy" pts), blood transfusions are a situation where we should treat the symptoms rather than the numbers. This is because there are risks associated with blood transfusions. The numbers you quoted can be helpful for test questions, but the real answer is that a pts who are not symptomatic should not receive blood tranfusions not matter what their hemoglobin is. Therefore there are no values (hemoglobin or hematocrit) below which we must always transfuse. UpToDate provides a historical perspective:

"For over 40 years, the decision to transfuse red blood cells was based upon the "10/30 rule": transfusion was indicated in all patients in order to maintain a blood hemoglobin concentration above 10 g/dL (100 g/L) and a hematocrit above 30 percent. However, concern regarding transmission of blood-borne pathogens and efforts at cost containment caused a reexamination of transfusion practices in the 1980s. The 1988 National Institutes of Health Consensus Conference on Perioperative Red Blood Cell Transfusions suggested that no single criterion should be used as an indication for red cell component therapy and that multiple factors related to the patient's clinical status and oxygen delivery needs should be considered. Accordingly, the decision to transfuse erythrocytes must be based upon an assessment of the risks of anemia versus the risks of transfusion ."
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Old 04-04-2011
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Hi healer,

Sorry, I've messed up the numbers. It should be the other way round. I've edited my post.

The issue is that often the patient in the case is hypotensive and symptomatic, and the question asks you what to give; saline or PRBC? The Hb or HCt is usually given.

For instance, a patient with a history of MI and who've had CABG; he lost a lot of blood during an operation, and now he's hypotensive, and his Hct is 25%. Should we transfuse PRBC to this patient?

And what if he was a healthy young man with no comorbidities?
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Old 04-04-2011
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I can't find any clear guidelines. However UTD did state the following:

"It is unlikely that transfusion is beneficial for patients with an ACS who have a hematocrit above 30 percent, but the benefits probably exceed the risks for patients with a hematocrit below 21 percent."
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Old 04-04-2011
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Default hope this helps

According to decision making guidelines in medicine book, which is very precise and accurate; the following is indicated:
1. Evaluate the patients volume status and correct if needed with crystalloids and colloids( correct it before evaluating Hgb and HCT)
2.Once you are normovolemic, evalute clinical status for signs & symptoms:
(Anemia, fatigue, lightheadedness, pallor, Tachycardia, DOE)
3. Hgb<7 in otherwise healthy ---> Transfuse RBCs in patients with cardiac disease earlier. This value can be as high as Hgb=10
Now for clarifications and gray zones:
They indicate:
-never transfuse for Hgb>10
-Always transfuse for Hgb<7
-The gray zone is in between. Which is a clinical choice based on severity of symptoms and etc.
Reference is a TRICC study, which showed an overall decrease in mortality for general population whom were only transfused when Hgb<7 and to maintain Hgb of about 7-9 rather than population whom recieved transfusion when Hgb < 10 to maintain Hgb 10-12. However this was not true for patients with acute MI and unstable angina. So in conclusion we generally transfuse those patients earlier.
Hope this sheds some light on the matter
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Quote:
Originally Posted by Haisook View Post
Hi healer,

Sorry, I've messed up the numbers. It should be the other way round. I've edited my post.

The issue is that often the patient in the case is hypotensive and symptomatic, and the question asks you what to give; saline or PRBC? The Hb or HCt is usually given.

For instance, a patient with a history of MI and who've had CABG; he lost a lot of blood during an operation, and now he's hypotensive, and his Hct is 25%. Should we transfuse PRBC to this patient?

And what if he was a healthy young man with no comorbidities?
Hi,

In your senario, there is a component of haemodilution (low hct) likely secondary to IV fluid perioperatively. So, would repeat HB, and if persistently less than 8 (UK), perhaps 7 according to metobe, would proceed with transfusion.

Hope it helps!
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