From Tolerating Anemia to Treating Anemia
Authors: Aryeh Shander, Lawrence Tim Goodnough
Journal: Annals of Internal Medicine (2018)

Editorials15 January 2019From Tolerating Anemia to Treating AnemiaAryeh Shander, MD and Lawrence Tim Goodnough, MDAryeh Shander, MDEnglewood Hospital and Medical Center, Englewood, New Jersey, Icahn School of Medicine at Mount Sinai, New York, New York, and Rutgers University, Newark, New Jersey (A.S.) and Lawrence Tim Goodnough, MDStanford University, Stanford, California (L.T.G.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3145 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Transfusion trials undoubtedly have transformed our view of the role of allogeneic blood in patient care, leading to a welcome shift toward reduced use of allogeneic red blood cell (RBC) transfusion. Nonetheless, this change arguably has also given rise to unintended consequences. As the name implies, a transfusion trial stays focused on comparing different transfusion strategies while placing the alternatives for managing anemia on the so-called back burner (1).The recent study by Roubinian and colleagues (2) is a timely revelation of some of these possible ramifications. Drawing on an extensive database of almost a half-million patient records, the authors ...References1. Shander A, Kim TY, Goodnough LT. Thresholds, triggers or requirements-time to look beyond the transfusion trials [Editorial]. J Thorac Dis. 2018;10:1152-1157. [PMID: 29708142] CrossrefMedlineGoogle Scholar2. Roubinian NH, Murphy EL, Mark DG, Triulzi DJ, Carson JL, Lee C, et al. Long-term outcomes among patients discharged from the hospital with moderate anemia: a retrospective cohort study. Ann Intern Med. 2019;170:81-9. doi:10.7326/M17-3253 LinkGoogle Scholar3. Shander A, Javidroozi M, Ozawa S, Hare GM. What is really dangerous: anaemia or transfusion? Br J Anaesth. 2011;107 Suppl 1:i41-59. [PMID: 22156270] CrossrefMedlineGoogle Scholar4. Carson JL, Stanworth SJ, Alexander JH, Roubinian N, Fergusson DA, Triulzi DJ, et al. Clinical trials evaluating red blood cell transfusion thresholds: an updated systematic review and with additional focus on patients with cardiovascular disease. Am Heart J. 2018;200:96-101. [PMID: 29898855] CrossrefMedlineGoogle Scholar5. Muñoz M, Acheson AG, Bisbe E, Butcher A, Gómez-Ramírez S, Khalafallah AA, et al. An international consensus statement on the management of postoperative anaemia after major surgical procedures. Anaesthesia. 2018;73:1418-1431. [PMID: 30062700] CrossrefMedlineGoogle Scholar6. Goodnough LT, Shander A. Current status of pharmacologic therapies in patient blood management. Anesth Analg. 2013;116:15-34. [PMID: 23223098] CrossrefMedlineGoogle Scholar7. Gross I, Trentino KM, Andreescu A, Pierson R, Maietta RA, Farmer S. Impact of a patient blood management program and an outpatient anemia management protocol on red cell transfusions in oncology inpatients and outpatients. Oncologist. 2016;21:327-32. [PMID: 26865590] CrossrefMedlineGoogle Scholar8. Muñoz M, Acheson AG, Auerbach M, Besser M, Habler O, Kehlet H, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72:233-247. [PMID: 27996086] CrossrefMedlineGoogle Scholar9. Goodnough LT, Nemeth E, Ganz T. Detection, evaluation, and management of iron-restricted erythropoiesis. Blood. 2010;116:4754-61. [PMID: 20826717] CrossrefMedlineGoogle Scholar10. Goodnough LT, Shander A. Patient blood management. Anesthesiology. 2012;116:1367-76. [PMID: 22487863] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Englewood Hospital and Medical Center, Englewood, New Jersey, Icahn School of Medicine at Mount Sinai, New York, New York, and Rutgers University, Newark, New Jersey (A.S.)Stanford University, Stanford, California (L.T.G.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3145.Corresponding Author: Lawrence Tim Goodnough, MD, Department of Pathology, Stanford University, 300 Pasteur Drive, Room H-1402, Stanford, CA 94305; e-mail, [email protected]edu.Current Author Addresses: Dr. Shander: Englewood Hospital and Medical Center, 350 Engle Street, Englewood, NJ 07631.Dr. Goodnough: Department of Pathology, Stanford University, 300 Pasteur Drive, Room H-1402, Stanford, CA 94305.This article was published at Annals.org on 18 December 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLong-Term Outcomes Among Patients Discharged From the Hospital With Moderate Anemia Nareg H. Roubinian , Edward L. Murphy , Dustin G. Mark , Darrell J. Triulzi , Jeffrey L. Carson , Catherine Lee , Patricia Kipnis , Steven Kleinman , Vincent X. Liu , and Gabriel J. Escobar Metrics Cited byEarly Post-Hospitalization Hemoglobin Recovery and Clinical Outcomes in Survivors of Critical Illness: A Population-Based Cohort StudyWhen to transfuse your acute care patient? A narrative review of the risk of anemia and red blood cell transfusion based on clinical trial outcomesTransfusión en urgencias ¿podemos mejorar?Transfusion in the emergency department. Can it be improved?Essential Role of Patient Blood Management in a Pandemic: A Call for ActionPerioperative AnemiaIs there an indication to utilize intravenous iron in acute trauma patients? Why, how, and whenStorage of BloodClinical decision support and improved blood use in patient blood managementReview of available evidence supporting different transfusion thresholds in different patient groups with anemiaRed blood cells: beyond the transfusion 15 January 2019Volume 170, Issue 2Page: 125-126KeywordsAnemiaBloodBlood transfusionDisclosureForecastingHemoglobinHospitalizationsMortalityQuality of lifeRed blood cells ePublished: 18 December 2018 Issue Published: 15 January 2019 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...