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Hemodynamic evaluation of blood transfusion in chronic severe anemia with special reference to speed of transfusion
Insights
Transfusing blood in patients with chronic severe anemia (CSA) can significantly increase left ventricular filling pressure (LVFP). Routine furosemide administration before blood transfusion (BT) effectively prevents this rise and allows faster transfusion rates safely.
Area of Science:
- Cardiology
- Hematology
- Critical Care Medicine
Background:
- Chronic severe anemia (CSA) presents unique challenges in fluid management.
- Left ventricular filling pressure (LVFP), often monitored via pulmonary capillary wedge pressure (PCWP), is a critical hemodynamic parameter.
- The impact of blood transfusion (BT) on LVFP in CSA patients requires careful evaluation.
Purpose of the Study:
- To investigate the effect of blood transfusion on LVFP in adult patients with CSA.
- To determine if furosemide administration can mitigate changes in PCWP during BT.
- To assess the safety and feasibility of faster blood transfusion rates in CSA patients.
Main Methods:
- 40 adult CSA patients were randomized into four groups for blood transfusion.
- Swan-Ganz catheters were used to measure PCWP before and after BT.
- Transfusion rates varied (2, 5, 10 ml/min), with one group receiving furosemide prior to BT.
Main Results:
- PCWP significantly increased post-transfusion in groups without furosemide, with a dose-dependent rise correlating with transfusion speed.
- In the group receiving furosemide, PCWP decreased significantly (p < 0.001).
- This is the first study documenting a significant PCWP rise even with conventional BT speeds.
Conclusions:
- Blood transfusion in CSA patients can lead to a significant, potentially detrimental, increase in LVFP.
- Pre-transfusion intravenous furosemide effectively prevents PCWP elevation during BT.
- Routine furosemide administration is recommended before BT in CSA to enhance patient safety and enable faster transfusion.
Abstract:
Left ventricular filling pressure (LVFP) as reflected by pulmonary capillary wedge pressure (PCWP) was measured in 40 adult cases of chronic severe anemia (CSA) before and after transfusion of 1 unit of whole citrated blood, using Swan-Ganz monitoring catheters. The cases were randomized into 4 groups of 10 each. Blood was transfused at a rate of 2 ml, 5 ml and 10 ml/min in groups A, B and C, respectively. In group D, blood transfusion (BT) was given at 5 ml/min but this group received, in addition, 40 mg furosemide intravenously just prior to the transfusion. Pretransfusion PCWP was normal in all the cases. Following BT the "wedge" pressure increased significantly in the first 3 groups, the rise being proportionately greater with faster transfusions (15.8, 20.9 and 32.2% in groups A, B and C, respectively). In group D, however, PCWP actually decreased by 21.7% (p less than 0.001). As far as we know, this is the first study in which a definite and significant rise in PCWP has been documented following transfusion of blood even at conventional speed (group A). The implications of such an increase in "wedge" pressure as well as the observation that it can be completely blocked by furosemide are discussed. On the basis of these observations it is recommended that intravenous furosemide should be administered routinely before any BT in cases of CSA. Such practice will also permit blood to be transfused at a comparatively faster speed, without jeopardizing patient safety.