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- Apr 12, 2007
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This week in the NEJM yet another article was published showing that a conservative goal (7) for Hgb has no impact on outcome versus Hgb of 9. The article is added to a pool of trials dating all the way back to the TRICC trial, all of which have failed to find that a lower threshold for transfusion is injurious. Also noted that 2 new sepsis trials, the ProCESS and the ARISE, failed to show that blood transfusion goal of HCT of 30 as per the original Rivers trial were helpful. Lastly the Study by Villanueva (NEJM 2013, 368:11-21) showed that higher transfusion goals in Upper GI bleeds worsened mortality.
Working both in the ICU and the OR I am always in conflict. In the ICU no one bats a eye with a HCT of 22 but in the OR I get calls to hang blood when the HCT is 25, 26,27, 28, 29. Obviously if the patient is showing hypotension with increasing base deficit or there is more anticipated blood loss I would transfuse earlier than later but what are other peoples practices? To note it doesn't seem to matter whether its a doc or crna in the case. Actually i find docs to be less in tune with new transfusion guidelines.
Another common issue is the hip fracture patient. When they sit on the medical floor the medicine guys, don't transfuse based on the above data but inevitably if they come down to the OR with a HCT <27 they will most likely need blood during the operation simply as a matter of ongoing loss during the case. I have read studies showing worse outcomes for the hip fx patient with OR transfusions but how do you all balance that? What are you protocols and/or personal decision making?
Working both in the ICU and the OR I am always in conflict. In the ICU no one bats a eye with a HCT of 22 but in the OR I get calls to hang blood when the HCT is 25, 26,27, 28, 29. Obviously if the patient is showing hypotension with increasing base deficit or there is more anticipated blood loss I would transfuse earlier than later but what are other peoples practices? To note it doesn't seem to matter whether its a doc or crna in the case. Actually i find docs to be less in tune with new transfusion guidelines.
Another common issue is the hip fracture patient. When they sit on the medical floor the medicine guys, don't transfuse based on the above data but inevitably if they come down to the OR with a HCT <27 they will most likely need blood during the operation simply as a matter of ongoing loss during the case. I have read studies showing worse outcomes for the hip fx patient with OR transfusions but how do you all balance that? What are you protocols and/or personal decision making?