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Red Blood Cell Transfusion Trigger in Cardiac Disease

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Transfusion in the Intensive Care Unit

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Abstract

There have been remarkable advancements in treating acute coronary syndrome with different angioplasty techniques, novel antithrombotic and antiplatelet agents, and heart failure therapies using mechanical assist devices. However, most of these interventions are done in patients with complex comorbidities, which lead to an increased risk of bleeding. Anemia is one of the most prevalent coexisting conditions in patients with heart failure and acute coronary syndrome. There is growing evidence that anemia in these patient populations is an independent predictor of mortality and adverse outcomes. Increasing the hemoglobin through blood transfusion should in theory increase oxygen delivery and reduce myocardial ischemia. However, there are several risks associated with transfusion. Randomized trials in some patient populations have demonstrated that restrictive use of blood transfusion, using a hemoglobin trigger of <7 g/dL, is associated with similar or even better outcomes compared with a liberal transfusion strategy using 10 g/dL as a transfusion trigger. However, it is not clear which strategy is safest for patients with ischemic heart disease or heart failure. The aim of this chapter is to describe and attempt to understand the pathophysiology of anemia in heart failure and ischemic heart disease and summarize recent advances and evidence behind using blood transfusion to treat anemia in patients with heart disease.

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Authors and Affiliations

  1. Internal Medicine, Englewood Medical Center, New Jersey, NJ, USA

    Parasuram Krishnamoorthy MD

  2. Division of Cardiology, Texas Tech University Health Sciences Center, El Paso, TX, USA

    Debabrata Mukherjee MD

  3. Division of Cardiology, St Luke’s-Roosevelt Hospital Center, Clark Building, 1111 Amsterdam Avenue, New York, NY, USA

    Saurav Chatterjee MD

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  1. Parasuram Krishnamoorthy MD
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  2. Debabrata Mukherjee MD
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  3. Saurav Chatterjee MD
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Correspondence to Saurav Chatterjee MD .

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Editors and Affiliations

  1. Department of Intensive Care L.E.I.C.A., Academic Medical Center, Amsterdam, The Netherlands

    Nicole P. Juffermans

  2. MRC Centre for Inflammation Research, University of Edinburgh The Queens Medical Research Institute, Edinburgh, United Kingdom

    Timothy S. Walsh

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Krishnamoorthy, P., Mukherjee, D., Chatterjee, S. (2015). Red Blood Cell Transfusion Trigger in Cardiac Disease. In: Juffermans, N., Walsh, T. (eds) Transfusion in the Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-319-08735-1_4

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  • DOI: https://doi.org/10.1007/978-3-319-08735-1_4

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