In patients with critical organ impairment, higher hemoglobin levels may be needed. The ultimate goal is to avoid symptoms of anemia while balancing the risks associated with transfusion. However, myocardial oxygen deficiency was detected in the group transfused at the lower level. 4 Oxygen delivery was adequate in both groups. The authors concluded that a restrictive red cell transfusion strategy is at least as effective and possibly superior to the liberal strategy in critically ill patients, with the possible exception of those with significant cardiac disease.
Descriptive reports provide additional information.
This finding was not replicated when the same investigators evaluated consecutive patients undergoing surgical repair of fractured hips. This implies a variance between the minimal hemoglobin levels needed to maintain oxygen carrying capacity and those needed for many daily activities. However, concern about adverse consequences of transfusion relegates most guidelines to focusing on minimal hemoglobin levels for achieving adequate tissue oxygenation. The Consensus Statement concluded that the decision to transfuse should be based on consideration of the duration of anemia and the presence of conditions that affect oxygen delivery, such as impaired pulmonary function, cardiac disease, or cardiovascular disease. The College of American Pathologists' guideline indicates that red cell transfusions should be given to minimize symptoms of anemia.