Welch H G, Meehan K R, Goodnough L T
Medical Service, White River Junction Veterans Affairs Hospital, VT 05001.
Ann Intern Med. 1992 Mar 1;116(5):393-402. doi: 10.7326/0003-4819-116-5-393.
To review the literature on the appropriateness of red blood cell transfusion and current physician practice, with emphasis on the physiologic and symptomatic implications of elective transfusion in the treatment of anemia.
Studies on the therapeutic use of red blood cell transfusion were identified through a search of MEDLINE (1966 to the present) and through a manual review of bibliographies of identified articles. In addition, evidence was solicited from selected experts in the field and recent consensus panels that have developed transfusion guidelines.
No controlled trials of blood transfusion were identified, but data were available on four issues relevant to transfusion practice: current physician practice and evidence for excessive use of red blood cell transfusion; physiologic adaptation to anemia; human tolerance of low hemoglobin levels; and strategies for reducing homologous transfusion requirements.
Despite the recent decline in red blood cell use because of concerns about infection, current transfusion practice remains variable because physicians have disparate views about its appropriateness. The remarkable human tolerance of anemia suggests that clinicians can accept hemoglobin levels above 70 g/L (7 g/dL) in most patients with self-limited anemia. In patients with impaired cardiovascular status or with anemias that will not resolve spontaneously, however, the data are insufficient to determine minimum acceptable hemoglobin levels, and therapy must be guided by the clinical situation. Several therapeutic strategies and pharmacologic interventions are available in the perioperative and non-operative settings to further reduce red blood cell use.
回顾关于红细胞输注的适宜性及当前医生实践的文献，重点关注择期输血治疗贫血的生理和症状学影响。
通过检索MEDLINE（1966年至今）以及人工查阅已识别文章的参考文献，确定了关于红细胞输注治疗用途的研究。此外，还向该领域的选定专家以及制定输血指南的近期共识小组征求了证据。
未找到输血的对照试验，但有关于输血实践相关四个问题的数据：当前医生实践及红细胞输注过度使用的证据；对贫血的生理适应；人体对低血红蛋白水平的耐受性；以及减少同源输血需求的策略。
尽管由于对感染的担忧，近期红细胞使用有所下降，但当前的输血实践仍存在差异，因为医生对其适宜性存在不同观点。人类对贫血的显著耐受性表明，对于大多数自限性贫血患者，临床医生可接受血红蛋白水平高于70 g/L（7 g/dL）。然而，对于心血管功能受损的患者或不会自发缓解的贫血患者，数据不足以确定最低可接受的血红蛋白水平，治疗必须根据临床情况进行指导。在围手术期和非手术环境中，有几种治疗策略和药物干预措施可进一步减少红细胞的使用。
