From the Division of Cardiothoracic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.
Ten years ago a National Institutes of Health Consensus Development
Conference1 challenged the conventional wisdom
that perioperative patients should receive red blood cell transfusion if their
hemoglobin level decreased to less than 100 g/L (hematocrit <0.30). This
transfusion trigger was replaced by a statement that "otherwise healthy patients
with hemoglobin values of 100 g/L or greater rarely require perioperative
transfusion, whereas those with acute anemia with resulting hemoglobin values
of less than 70 g/L frequently will require red blood cell transfusions."
In this issue of THE JOURNAL, Carson et al2
assessed the hemoglobin level at which patients were given a transfusion following
surgery. In their retrospective study of 8787 patients with hip fracture who
underwent surgical repair between 1983 and 1993, Carson et al2
found that only 6.6% of patients with a postoperative hemoglobin level of
100 g/L or greater received a transfusion, while 95% of patients with a hemoglobin
level of less than 70 g/L received one. For patients with a hemoglobin level
between 80 g/L and 99 g/L, practice varied considerably: 55.6% received a
red blood cell transfusion. However, red blood cell transfusion was not associated
with reduced mortality, even when the presence of underlying cardiovascular
disease was considered. Although other outcome measures such as time to recovery
were not studied, Carson et al2 suggest that,
at least for patients in their study, red blood cell transfusion may not be
necessary even for elderly patients with hemoglobin levels as low as 80 g/L.
Thurer RL. Evaluating Transfusion Triggers. JAMA. 1998;279(3):238-239. doi:10.1001/jama.279.3.238