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Published on: March 14, 2017
Transfusion in the cardiac patient
Donat R Spahn1, Nadia Dettori, Roman Kocian
1Department of Anesthesiology, University Hospital Lausanne (CHUV), CH-1011 Lausanne, Switzerland. donat.spahn@chuv.hospvd.ch
Insights
Transfusion guidelines for cardiac patients are similar to others, with triggers above 6.0 g/dL hemoglobin. Signs of inadequate oxygenation, like hemodynamic instability or ischemia, guide transfusions in this group.
Area of Science:
- Cardiology
- Transfusion Medicine
Background:
- Cardiac disease complicates transfusion decisions.
- Existing guidelines offer a general framework for blood transfusions.
Purpose of the Study:
- To define specific transfusion guidelines for patients with coexisting cardiac diseases.
- To identify objective measures of inadequate oxygenation in cardiac patients.
Main Methods:
- Review of current transfusion guidelines.
- Analysis of clinical indicators for inadequate oxygenation (hemodynamic instability, myocardial ischemia).
- Consideration of institutional factors influencing transfusion triggers.
Main Results:
- Transfusion indications are generally similar, with triggers <6.0 g/dL and rarely >10 g/dL hemoglobin.
- In the 6-10 g/dL range, signs of impaired oxygenation dictate transfusions.
- Indicators include hemodynamic instability (hypotension, tachycardia) or myocardial ischemia (ECG changes, wall motion abnormalities).
Conclusions:
- Transfusion guidelines for cardiac patients align with general populations but require monitoring for oxygenation.
- Hemodynamic instability and myocardial ischemia are key indicators for transfusion in cardiac patients.
- Local factors like staff expertise and surveillance may influence higher hemoglobin transfusion triggers, especially postoperatively.
Abstract:
Transfusion guidelines in patients with coexisting cardiac diseases are similar to the ones in patients without such comorbidity, in that allogeneic blood transfusions most often are indicated at hemoglobin levels of less than 6.0 g/dL and hardly ever at hemoglobin levels greater than 10 g/dL. In the hemoglobin range of 6 to 10 g/dL, signs of impaired oxygenation should serve as transfusion indications, and such signs may be reached at higher hemoglobin values than in healthy patients. An inadequate oxygenation may become manifest globally in the form of a general hemodynamic instability with a tendency to hypotension and tachycardia despite normovolemia or an oxygen extraction of greater than 50%. An inadequate oxygenation in the form of myocardial ischemia may be manifested by new ST-segment depressions of greater than 0.1 mV, new ST-segment elevations greater than 0.2 mV, or new wall motion abnormalities in transesophageal echocardiography. Institutional guidelines also should consider local logistic characteristics such as the level of knowledge of physician and nurse staff caring for patients and the level of surveillance possible justifying eventually higher hemoglobin transfusion triggers, particularly in the postoperative period.
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