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Transfusion of packed red blood cells in patients with ischemic heart disease
1University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, and Medical-Surgical Intensive Care Unit, Cooper University Hospital, Camden, NJ, USA. gerber-dave@cooperhealth.edu
Insights
Transfusion of packed red blood cells (PRBC) offers limited benefit and potential harm for patients with ischemic heart disease. Routine transfusion is not recommended, except possibly for anemic patients with ST-elevation myocardial infarction.
Area of Science:
- Cardiology
- Transfusion Medicine
- Critical Care Medicine
Background:
- Packed red blood cell (PRBC) transfusions are common in critically ill patients.
- Ischemic heart disease (IHD) patients represent a significant subgroup receiving PRBCs.
- Understanding the risks and benefits of PRBC transfusion in IHD is crucial.
Purpose of the Study:
- To review the current literature on the utility and complications of PRBC transfusion in medical and surgical patients with IHD.
- To synthesize evidence regarding the safety and efficacy of PRBC transfusion in this specific patient population.
Main Methods:
- Comprehensive literature search of the PubMed database (post-1999).
- Inclusion of relevant earlier background literature.
- Review of various study designs including retrospective reviews, database analyses, and prospective studies.
Main Results:
- A large body of literature exists, though often retrospective with varied methodologies.
- The majority of evidence suggests limited clinical utility of PRBC transfusion in IHD patients.
- Potential for serious adverse consequences associated with PRBC transfusion in this population.
Conclusions:
- Routine PRBC transfusion is not indicated for non-ST-elevation acute coronary syndrome.
- Anemic patients with ST-elevation myocardial infarction may benefit from PRBC transfusion.
- Specific indications for PRBC transfusion in IHD patients remain poorly defined.
Objective:
To review the current literature concerning the utility of and complications associated with transfusion of packed red blood cells (PRBC) in medical and surgical patients with ischemic heart disease.
Data Sources, Study Selection, And Data Extraction:
The PubMed database of the National Library of Medicine was searched for all studies investigating the use of PRBC in medical and surgical patients with cardiac disease published since 1999. Relevant background literature from before that date was reviewed for inclusion as well.
Data Synthesis:
An extensive body of literature has accumulated evaluating the safety and efficacy of transfusion as a therapeutic modality in a wide variety of critically ill patients, including patients with cardiac disease. Most, but not all, of these studies have been retrospective in nature, and methodologies have varied from study to study. Some have involved retrospective reviews of patient records, some have been retrospective analyses of detailed databases prospectively collected for other purposes, and some have been prospective randomized or observational studies. Despite the variability in data sources and study design, with a handful of exceptions, the preponderance of data indicates that transfusion of PRBC in the population of patients with ischemic heart disease is of limited clinical utility and may carry the potential for serious adverse consequences.
Conclusions:
Based on the current literature, there appears to be no indication for routine transfusion in patients with non-ST-elevation acute coronary syndrome, although anemic patients with ST-elevation myocardial infarction may benefit from this intervention. However, the specific indications for transfusion in this population remain ill-defined.
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