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(Circulation. 2007;116:458-460.)
© 2007 American Heart Association, Inc.

Editorial

To Transfuse or Not to Transfuse

Timothy J. Gardner, MD

From Christiana Care Health System, The Center for Heart and Vascular Health, Newark Del.

Correspondence to Timothy J. Gardner, MD, Christiana Care Health System, The Center for Heart and Vascular Health, 4745 Ogletown-Stanton Rd, Newark DE 19718. E-mail tgardner@christianacare.org

Key Words: Editorials • blood cells • anemia • bypass • transfusions

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Preoperative anemia in a patient requiring cardiac surgery generally is not considered an independent risk factor for an unfavorable outcome. Older and sicker patients, especially women, are more likely to be anemic, but these patients often are at higher risk because of other coexisting comorbidities. It is these other comorbidities and risk factors that are accounted for in most risk-prediction models of patients undergoing heart surgery. The present report by Kulier et al¹ demonstrates that anemia itself is a risk factor and that the degree of risk is proportional to the level of anemia. This finding, however, uncovers a common dilemma in the management of cardiac surgery patients. The controversy revolves around whether and even how best to deal with the anemia that is encountered in most cardiac surgery patients before, during, and after the surgery. This "transfusion" dilemma is a result of many equally compelling reports on the detrimental effects of blood transfusions in critically ill postoperative patients, including specific reports in cardiac surgery populations.

Article p 471

It is well recognized that moderate to severe preoperative anemia, with hemoglobin (Hb) levels of 10 g/dL or less, can complicate what would otherwise be a straightforward cardiac operation. The hemodilution that occurs as a result of the pump priming volume required to establish cardiopulmonary bypass may not be tolerated by anemic patients without the addition of red blood cells (RBCs) to the prime or to the pump circuit once bypass has begun. In addition, tolerable levels of anemia in the . . . [Full Text of this Article]

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Circulation 2007 116: 457. [Extract] [Full Text]

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