The bloody mess of red blood cell transfusion
Abstract Red blood cell (RBC) transfusion might be life-saving in settings with acute blood loss, especially uncontrolled haemorrhagic shock. However, there appears to be a catch-22 situation reflected by the facts that preoperative anaemia represents an independent risk factor for postoperative mor...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-12-01
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| Series: | Critical Care |
| Online Access: | http://link.springer.com/article/10.1186/s13054-017-1912-x |
| _version_ | 1818270276616454144 |
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| author | Susilo Chandra Hrishikesh Kulkarni Martin Westphal |
| author_facet | Susilo Chandra Hrishikesh Kulkarni Martin Westphal |
| author_sort | Susilo Chandra |
| collection | DOAJ |
| description | Abstract Red blood cell (RBC) transfusion might be life-saving in settings with acute blood loss, especially uncontrolled haemorrhagic shock. However, there appears to be a catch-22 situation reflected by the facts that preoperative anaemia represents an independent risk factor for postoperative morbidity and mortality, and that RBC transfusion might also contribute to adverse clinical outcomes. This dilemma is further complicated by the difficulty to define the “best” transfusion trigger and strategy. Since one size does obviously not fit all, a personalised approach is merited. Attempts should thus be made to critically reflect on the pros and cons of RBC transfusion in each individual patient. Patient blood management concepts including preoperative, intraoperative and postoperative optimisation strategies involving the intensive care unit are warranted and are likely to provide benefits for the patients and the healthcare system. In this context, it is important to consider that “simply” increasing the haemoglobin content, and in proportion oxygen delivery, may not necessarily contribute to a better outcome but potentially the contrary in the long term. The difficulty lies in identification of the patients who might eventually profit from RBC transfusion and to determine in whom a transfusion might be withheld without inducing harm. More robust clinical data providing long-term outcome data are needed to better understand in which patients RBC transfusion might be life-saving vs life-limiting. |
| first_indexed | 2024-12-12T21:07:43Z |
| format | Article |
| id | doaj.art-7d8cce7911ff45a6aee0acbb90bf0145 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-12T21:07:43Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-7d8cce7911ff45a6aee0acbb90bf01452022-12-22T00:11:59ZengBMCCritical Care1364-85352017-12-0121S3636810.1186/s13054-017-1912-xThe bloody mess of red blood cell transfusionSusilo Chandra0Hrishikesh Kulkarni1Martin Westphal2Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo General Hospital, University of Indonesia, Medical FacultyFresenius KabiFresenius KabiAbstract Red blood cell (RBC) transfusion might be life-saving in settings with acute blood loss, especially uncontrolled haemorrhagic shock. However, there appears to be a catch-22 situation reflected by the facts that preoperative anaemia represents an independent risk factor for postoperative morbidity and mortality, and that RBC transfusion might also contribute to adverse clinical outcomes. This dilemma is further complicated by the difficulty to define the “best” transfusion trigger and strategy. Since one size does obviously not fit all, a personalised approach is merited. Attempts should thus be made to critically reflect on the pros and cons of RBC transfusion in each individual patient. Patient blood management concepts including preoperative, intraoperative and postoperative optimisation strategies involving the intensive care unit are warranted and are likely to provide benefits for the patients and the healthcare system. In this context, it is important to consider that “simply” increasing the haemoglobin content, and in proportion oxygen delivery, may not necessarily contribute to a better outcome but potentially the contrary in the long term. The difficulty lies in identification of the patients who might eventually profit from RBC transfusion and to determine in whom a transfusion might be withheld without inducing harm. More robust clinical data providing long-term outcome data are needed to better understand in which patients RBC transfusion might be life-saving vs life-limiting.http://link.springer.com/article/10.1186/s13054-017-1912-x |
| spellingShingle | Susilo Chandra Hrishikesh Kulkarni Martin Westphal The bloody mess of red blood cell transfusion Critical Care |
| title | The bloody mess of red blood cell transfusion |
| title_full | The bloody mess of red blood cell transfusion |
| title_fullStr | The bloody mess of red blood cell transfusion |
| title_full_unstemmed | The bloody mess of red blood cell transfusion |
| title_short | The bloody mess of red blood cell transfusion |
| title_sort | bloody mess of red blood cell transfusion |
| url | http://link.springer.com/article/10.1186/s13054-017-1912-x |
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