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A Physiologic Basis for the Transfusion Trigger

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Blood Substitutes

Abstract

Allogeneic blood for transfusion is now rigorously tested and the risk of contamination with pathogens is extremely low. The decision to transfuse a given patient should be based on the need for transfusion, not just on an estimation of the risks. Transfusion requirements need to be understood on physiological grounds, but there is no clear-cut “transfusion trigger” that emerges from this understanding. Rather, the clinician must combine physiologic parameters such as \(P\bar{v}{{O}_{2}}, S\bar{v}{{O}_{2}}\), O2 extraction ratio and \(\dot{V}{{O}_{2}}\) (when available) with clinical signs and symptoms to provide a rationale for transfusion of individual patients.

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References

  • American College of Physicians. Practice strategies for elective red blood cell transfusion.Ann. Int. Med.116: 403–406, 1992.

    Google Scholar 

  • Babineau, T.J., W.H. Dzik, B.C. Borlase, J.K. Baxter, B.R. Bistrian, and P.N. Benotti. Reevaluation of current transfusion practices in patients in surgical intensive care units.Am. J. Surg.164: 22–25, 1992.

    Article  PubMed  CAS  Google Scholar 

  • Dodd, R.Y. The risk of transfusion-transmitted infection.N. Engl. J. Med.327: 419–420, 1992.

    Article  PubMed  CAS  Google Scholar 

  • Goodnough, L.T., D. Verbrugge, K. Vizmeg, and J. Riddell. Identifying elective orthopedic surgical patients transfused with amounts of blood in excess of need: the transfusion trigger revisited.Transfusion32: 648–653, 1992.

    Article  PubMed  CAS  Google Scholar 

  • Gould, SA., A.L. Rosen, L.R. Sehgal, H.L. Seghal, LA. Langdale, L.M. Krause, and G.S. Moss. O2 extraction ratio: A physiologic indicator of transfusion need.Transfusion23: 416 (abstract), 1983.

    Google Scholar 

  • Guyton, A.C., C.E. Jones, and T.G. Coleman. Cardiac Output and Its Regulation. 2 nd edition. Philadelphia: Saunders, 1973.

    Google Scholar 

  • Hanique, G., T. Dugernier, P.F. Laterre, A Dougnac, J. Roeseler, and M.S. Reynaert. Significance of pathologic oxygen supply dependency in critically ill patients: comparison between measured and calculated methods.Intensive Care Med. 20: 12–18, 1994.

    Article  PubMed  CAS  Google Scholar 

  • Levine, E., A Rosen, L. Sehgal, S. Gould, H. Sehgal, and G. Moss.Physiologic effects of acute anemia: implications for a reduced transfusion trigger.Transfusion30: 11–14 1990.

    Article  PubMed  CAS  Google Scholar 

  • Levy, P.S., R.P. Chavez, G.J. Crystal, S.J. Kim, P.K. Eckel, L.R. Sehgal, H.L. Sehgal, M.R. Salem, and S.A. Gould. Oxygen extraction ratio: a valid indicator of transfusion need in coronary vascular reserve?J. Trauma32: 769–773, 1992.

    Article  PubMed  CAS  Google Scholar 

  • Lorente, J.A., L. Landin, R. DePablo, E. Renes, R. Rodriguez-Diaz, and D. Liste. Effects of blood transfusion on oxygen transport variables in severe sepsis.Crit. Care Med.21: 1312–1318, 1993.

    Article  PubMed  CAS  Google Scholar 

  • Lucking, S.E., T.M. Williams, F.C. Chaten, R.I. Metz, and J.J. Mickell. Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction [see comments].Crit. Care Med.18: 1316–1319, 1990.

    Article  PubMed  CAS  Google Scholar 

  • Marik, P.E., and W.J. Sibbald. Effect of stored-blood transfusion on oxygen delivery in patients with sepsis.J. A. M. A.269: 3024–3029, 1993.

    Article  PubMed  CAS  Google Scholar 

  • Mathru, M., B. Kleinman, B. Blakeman, H. Sullivan, P. Kumar, and D.J. Dries. Myocardial metabolism and adaptation during extreme hemodilution in humans after coronary revascularization. Crit. Care Med.20: 1420–1425, 1992.

    Article  PubMed  CAS  Google Scholar 

  • Messmer, K., D.H. Lewis, L. Sunder-Plassmann, W.P. Klovekorn, N. Mendler, and K. Holper, Acute normovolemic hemodilution. Changes of central hemodynamics and microcirculatory flow in skeletal muscle.Eur. Surg. Res.4: 55–70, 1972.

    Article  PubMed  CAS  Google Scholar 

  • Mink, R.B., and M.M. Pollack. Effect of blood transfusion on oxygen consumption in pediatric septic shock [see comments].Crit. Care Med.18: 1087–1091, 1990.

    Article  PubMed  CAS  Google Scholar 

  • Mollison, P.L.. Blood Transfusion in Clinical Medicine. 7 th Edition. Philadelphia: FA Davis, 1983.

    Google Scholar 

  • National Institutes of Health Consensus Conference. Perioperative Red Cell Transfusion. J. Amer. Med. Assoc.260: 2700–2703, 1988.

    Article  Google Scholar 

  • Ronco, J.J., J.S. Montaner, J.C. Fenwick, and J.A. Russell. Pathologic dependence of oxygen consumption on oxygen delivery in a respiratory failure secondary to AIDS-relatedPneumocystis cariniipneumonia.Chest98: 1463–1466, 1990.

    Article  PubMed  CAS  Google Scholar 

  • Ronco, J.J., P.T. Phang, K.R. Walley, B. Wiggs, J.C. Fenwick, and J.A. Russell. Oxygen consumption is independent of changes in oxygen delivery in adult respiratory distress syndrome [see comments].Am. Rev. Respir. Dis.143: 1267–1273, 1991.

    PubMed  CAS  Google Scholar 

  • Roughton, F. J.W., and R.E. Forster. Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human with special reference to true diffusing capacity of pulmonary.J. Appi. Physiol.11: 290–302, 1957.

    CAS  Google Scholar 

  • Samaja, M., and R.M. Winslow. The separate effects of H+ and 2,3DPG on the oxygen equilibrium curve of human blood.Br. J. Haem.41: 373–381, 1979.

    Article  CAS  Google Scholar 

  • Seear, M., D. Wensley, and A. MacNab. Oxygen consumption-oxygen delivery relationship in children.J. Pediatr.123: 208–214, 1993.

    Article  PubMed  CAS  Google Scholar 

  • Shoemaker, W.C., P.L. Appel, H.B. Kram, and T.-S. Lee. Comparison of two monitoring methods (central venous pressure versus pulmonary artery catheter) and two protocols as therapeutic goals (normal values versus values of survivors) in a prospective randomized clinical trial of critically ill surgical patients.Crit. Care Med.13: 304, 1985.

    Article  Google Scholar 

  • Spiess, B.D., K.J. Tuman, R.J. McCarthy, W.G. Logas, T.R. Lubenow, J. Williams, H. Sankray, and P. Foster. Oxygen consumption and mixed venous oxygen saturation monitoring during orthotopic liver transplantation.J. Clin. Monit.8: 7–11, 1992.

    Article  PubMed  CAS  Google Scholar 

  • Stehling, L., and T.L. Simon. The red blood cell transfusion trigger. Physiology and clinical studies.Arch. Pathol. Lab. Med.118: 429–344, 1994.

    PubMed  CAS  Google Scholar 

  • Swisher, S.N., and L.D. Petz. Clinical Practice of Transfusion. 2 nd Edition. Churchill Livingstone, pp. 531–548, 1989.

    Google Scholar 

  • Tomasulo, P.. World-wide blood supply and its impact on development of blood substitutes. In Blood Substitutes: Physiological Basis of Efficacy (R.M. Winslow, K. D. Vandegriff, and M. Intaglietta, eds.) Boston: Birkhäuser, 1995, pp. 1–19.

    Google Scholar 

  • Wagner, P.D. Diffusion and chemical reaction in pulmonary gas exchange.Physiol. Rev.57: 257–312, 1977.

    PubMed  CAS  Google Scholar 

  • Winslow, R.M.. A model for red cell 02 uptake.Int. J. Clin. Monit. Comput.2: 81–93, 1985.

    Article  PubMed  CAS  Google Scholar 

  • Winslow, R.M. Hemoglobin-based Red Cell Substitutes. Baltimore: Johns Hopkins University Press, 1992.

    Google Scholar 

  • Winslow, R.M., and C.C. Monge. Hypoxia, Polycythemia, and Chronic Mountain Sickness. Baltimore: Johns Hopkins University Press, 1987.

    Google Scholar 

  • Winslow, R.M., M. Samaja, N.J. Winslow, L. Rossi-Bernardi, and R.I. Shrager. Simulation of the continuous O2 equilibrium curve over the physiologic range of pH, 2,3-diphosphoglycerate, and pCO2.J. Appi. Physiol.54: 524–529, 1983.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, School of Medicine, University of California, San Diego, Veterans Affairs Medical Center (111-E), 3350 La Jolla Village Drive, 92161, San Diego, California, USA

    Robert M. Winslow M.D.

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  1. Robert M. Winslow M.D.
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Editors and Affiliations

  1. School of Medicine, University of California, 92161, San Diego, CA, USA

    R. M. Winslow

  2. School of Medicine, University of California, 92161, San Diego, CA, USA

    K. D. Vandegriff

  3. Department of Applied Mechanics and Engineering Sciences, University of California, 92161, San Diego, CA, USA

    M. Intaglietta

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© 1995 Birkhäuser Boston

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Winslow, R.M. (1995). A Physiologic Basis for the Transfusion Trigger. In: Winslow, R.M., Vandegriff, K.D., Intaglietta, M. (eds) Blood Substitutes. Birkhäuser Boston. https://doi.org/10.1007/978-1-4612-2576-8_3

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  • DOI: https://doi.org/10.1007/978-1-4612-2576-8_3

  • Publisher Name: Birkhäuser Boston

  • Print ISBN: 978-1-4612-7587-9

  • Online ISBN: 978-1-4612-2576-8

  • eBook Packages: Springer Book Archive

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