Carmel R, Shulman I A
Department of Medicine, University of Southern California, School of Medicine, Los Angeles 90033.
Arch Pathol Lab Med. 1989 Sep;113(9):995-7.
Transfusion practice in patients with treatable, readily recognizable, chronic anemia was reviewed because such patients only infrequently need to be transfused. Pernicious anemia with hemoglobin concentration below 100 g/L was chosen as the model for this assessment. Sixty-two (51%) of 122 patients received blood transfusion, although most patients had chronic, low-grade symptoms despite their low hemoglobin levels and could have been satisfactorily managed without transfusion. Only 34 of the 122 had findings suggesting an urgent need to raise the blood cell count, but their transfusion rate (44%) was no different from that in patients without such findings. These observations in pernicious anemia indicate that transfusion of patients with medically reversible anemia is a common problem. They further suggest that current transfusion usage overemphasizes laboratory results (ie, hemoglobin levels) at the expense of clinical assessment of severity of symptoms. Improvement of current practice is needed, particularly in view of valid concerns about the serious side effects of transfusion, shortages of available blood resources, and health care costs.
对患有可治疗、易于识别的慢性贫血患者的输血情况进行了回顾，因为这类患者很少需要输血。以血红蛋白浓度低于100g/L的恶性贫血作为此次评估的模型。122例患者中有62例（51%）接受了输血，尽管大多数患者血红蛋白水平低，但仍有慢性、轻度症状，即便不输血也可得到满意的治疗。122例中只有34例有迹象表明急需提高血细胞计数，但其输血率（44%）与无此类迹象的患者并无差异。这些关于恶性贫血的观察结果表明，对药物可逆转贫血患者进行输血是一个常见问题。它们还进一步表明，目前的输血使用过度强调实验室结果（即血红蛋白水平），而忽视了对症状严重程度的临床评估。需要改进当前的做法，特别是考虑到对输血严重副作用、可用血液资源短缺以及医疗保健成本的合理担忧。
