The Limits of Acute Anemia.
Tina Tomić MahečićRoxane BrooksMatthias NoitzIgnacio SarmientoRobert BaronicaJens MeierPublished in: Journal of clinical medicine (2022)
For many years, physicians' approach to the transfusion of allogeneic red blood cells (RBC) was not individualized. It was accepted that a hemoglobin concentration (Hb) of less than 10 g/dL was a general transfusion threshold and the majority of patients were transfused immediately. In recent years, there has been increasing evidence that even significantly lower hemoglobin concentrations can be survived in the short term without sequelae. This somehow contradicts the observation that moderate or mild anemia is associated with relevant long-term morbidity and mortality. To resolve this apparent contradiction, it must be recognized that we have to avoid acute anemia or treat it by alternative methods. The aim of this article is to describe the physiological limits of acute anemia, match these considerations with clinical realities, and then present "patient blood management" (PBM) as the therapeutic concept that can prevent both anemia and unnecessary transfusion of RBC concentrates in a clinical context, especially in Intensive Care Units (ICU). This treatment concept may prove to be the key to high-quality patient care in the ICU setting in the future.
Keyphrases
- red blood cell
- chronic kidney disease
- end stage renal disease
- iron deficiency
- liver failure
- intensive care unit
- respiratory failure
- cardiac surgery
- mechanical ventilation
- drug induced
- aortic dissection
- primary care
- stem cell transplantation
- newly diagnosed
- ejection fraction
- sickle cell disease
- magnetic resonance imaging
- computed tomography
- low dose
- acute kidney injury
- prognostic factors
- case report
- magnetic resonance
- high intensity
- combination therapy
- patient reported outcomes
- extracorporeal membrane oxygenation
- current status