Saxena S, Rabinowitz A P, Johnson C, Shulman I A
Department of Pathology, Los Angeles County and University of Southern California Medical Center 90033.
Am J Med. 1993 Feb;94(2):120-4. doi: 10.1016/0002-9343(93)90172-l.
Transfusion practice in patients with iron deficiency was reviewed.
During the study period, records of 265 consecutive patients with an unsaturated iron-binding capacity of greater than 53.7 mumol/L were evaluated for possible iron-deficiency anemia.
Two hundred sixty-three patients met the study criteria for iron deficiency. Of these patients, 50 received 1 or more units of red blood cells (RBCs). The transfusion therapy of 12 patients could not be justified; physicians used laboratory results rather than the clinical status of the patients to initiate transfusion therapy. As a result, units of RBCs were transfused to raise the hematocrit to an arbitrarily chosen level. Furthermore, iron therapy was not prescribed for 97 of the 263 iron-deficient patients, including 11 of the patients for whom transfusion was justifiable and 2 patients for whom transfusion could not be justified. Based on records reviewed, no work-up was initiated to identify the cause of iron deficiency in 13 patients, including 4 patients who received transfusions.
These findings suggest that the evaluation and treatment of iron deficiency, including transfusion therapy for that condition, may be problematic. In view of the risks of blood transfusion therapy, improvement in transfusion practices for iron deficiency should be emphasized.
对缺铁患者的输血情况进行回顾。
在研究期间，对连续265例未饱和铁结合能力大于53.7微摩尔/升的患者记录进行评估，以确定是否可能患有缺铁性贫血。
263例患者符合缺铁的研究标准。在这些患者中，50例接受了1个或更多单位的红细胞（RBC）输注。12例患者的输血治疗不合理；医生根据实验室结果而非患者的临床状况启动输血治疗。结果，输注红细胞单位是为了将血细胞比容提高到任意选定的水平。此外，263例缺铁患者中有97例未接受铁剂治疗，其中包括11例输血合理的患者和2例输血不合理的患者。根据所审查的记录，13例患者未开展检查以确定缺铁原因，其中包括4例接受输血的患者。
这些发现表明，缺铁的评估和治疗，包括针对该病症的输血治疗，可能存在问题。鉴于输血治疗的风险，应强调改善缺铁患者的输血做法。
