Transfusion Strategy: Impact of Haemodynamics and the Challenge of HaemodilutionReport as inadecuate




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Journal of Blood TransfusionVolume 2014 2014, Article ID 627141, 12 pages

Review ArticleDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, 8200 Aarhus N, Denmark

Received 18 June 2014; Accepted 17 July 2014; Published 6 August 2014

Academic Editor: Erwin Strasser

Copyright © 2014 Carl-Johan Jakobsen. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Blood transfusion is associated with increased morbidity and mortality and numerous reports have emphasised the need for reduction. Following this there is increased attention to the concept of patient blood management. However, bleeding is relatively common following cardiac surgery and is further enhanced by the continued antiplatelet therapy policy. Another important issue is that cardiopulmonary bypass leads to haemodilution and a potential blood loss. The basic role of blood is oxygen transport to the organs. The determining factors of oxygen delivery are cardiac output, haemoglobin, and saturation. If oxygen delivery-consumption is out of balance, the compensation mechanisms are simple, as a decrease in one factor results in an increase in one or two other factors. Patients with coexisting cardiac diseases may be of particular risk, but studies indicate that patients with coexisting cardiac diseases tolerate moderate anaemia and may even benefit from a restrictive transfusion regimen. Further it has been shown that patients with reduced left ventricular function are able to compensate with increased cardiac output in response to bleeding and haemodilution if normovolaemia is maintained. In conclusion the evidence supports that each institution establishes its own patient blood management strategy to both conserve blood products and maximise outcome.





Author: Carl-Johan Jakobsen

Source: https://www.hindawi.com/



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