Department of Anesthesiology and Critical Care Medicine; Englewood Hospital and Medical Center.
TeamHealth Research Institute; Englewood.
Curr Opin Anaesthesiol. 2020 Apr;33(2):220-226. doi: 10.1097/ACO.0000000000000837.
Red cell transfusions are commonly used in management of hemorrhage in trauma patients. The appropriate indications and criteria for transfusion are still debated. Here, we summarize the recent findings on the use of red cell transfusion in trauma setting.
Recent evidence continues to support the long-established link between allogeneic transfusion and worse clinical outcomes, reinstating the importance of more judicious use of allogeneic blood and careful consideration of benefits versus risks when making transfusion decisions. Studies support restrictive transfusion strategies (often based on hemoglobin thresholds of 7-8 g/dl) in most patient populations, although some argue more caution in specific populations (e.g. patients with traumatic brain injury) and more studies are needed to determine if these patients benefit from less restrictive transfusion strategies. It should be remembered that anemia remains an independent risk factor for worse outcomes and red cell transfusion does not constitute a lasting treatment. Anemia should be properly assessed and managed based on the cause and using hematinic medications as indicated.
Although the debate on hemoglobin thresholds for transfusion continues, clinicians should not overlook proper management of the underlying issue (anemia).
红细胞输注在创伤患者出血的管理中被广泛应用。但目前对于输血的适应证和标准仍存在争议。本文总结了近期有关创伤患者红细胞输注应用的研究结果。
最近的证据再次证实了异体输血与临床预后不良之间的长期关联，这重新强调了在制定输血决策时更合理地使用异体血液以及权衡利弊的重要性。研究支持在大多数患者人群中采用限制性输血策略（通常基于血红蛋白阈值为 7-8g/dl），但也有一些研究认为在特定人群（如创伤性脑损伤患者）中需要更加谨慎，并且需要更多的研究来确定这些患者是否从更宽松的输血策略中获益。应当记住，贫血仍然是影响预后的独立危险因素，而且红细胞输注并不能作为持久的治疗手段。应根据病因适当评估和管理贫血，并在需要时使用血液生成药物。
尽管关于输血血红蛋白阈值的争论仍在继续，但临床医生不应忽视对潜在问题（贫血）的适当管理。
