Department of Medicine, Division of General Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Curr Opin Hematol. 2013 Nov;20(6):546-51. doi: 10.1097/MOH.0b013e32836508bd.
This review provides a summary of the clinical trials evaluating transfusion thresholds and recommendations for red blood cell transfusion. We highlight the trial results in patients in the critical care setting, undergoing surgery, and patients with gastrointestinal bleed, acute coronary syndrome, and acute brain injury.
Clinical trials in hip fracture patients with underlying cardiovascular disease or risk factors, and in cardiac surgery, support the findings from prior studies in intensive care unit patients that restrictive transfusion (7-8 g/dl) is well tolerated even in elderly high-risk patients. Restrictive transfusion strategy (7 g/dl) was further supported by the statistically lower mortality in patients with gastrointestinal bleeding compared with liberal transfusion (10 g/dl) strategy. Pilot trials in acute coronary syndrome raise the possibility that liberal transfusion improves outcome, but large trials are needed.
A restrictive transfusion strategy of administering red blood cell transfusion in patients with hemoglobin concentration of 7-8 g/dl in most patients is supported by randomized clinical trials. Further randomized clinical trials are needed to establish the optimal transfusion threshold in patients with acute coronary syndrome and brain injury, and to elucidate physiological triggers.
本综述总结了评估输血阈值和红细胞输血推荐的临床试验。我们重点介绍了重症监护、手术、胃肠道出血、急性冠状动脉综合征和急性脑损伤患者的试验结果。
有潜在心血管疾病或危险因素的髋部骨折患者以及心脏手术的临床试验支持了重症监护病房患者的先前研究结果，即限制输血（7-8g/dl）即使在老年高危患者中也能很好耐受。胃肠道出血患者的限制性输血策略（7g/dl）与自由输血（10g/dl）策略相比，死亡率更低，进一步支持了该策略。急性冠状动脉综合征的初步试验提出了自由输血可能改善预后的可能性，但需要进行大型试验。
大多数患者血红蛋白浓度为 7-8g/dl 时给予红细胞输血的限制输血策略得到了随机临床试验的支持。需要进一步的随机临床试验来确定急性冠状动脉综合征和脑损伤患者的最佳输血阈值，并阐明生理触发因素。
