• Transfusion · Jun 2014

    Clinical predictors of postoperative hemoglobin drift.

    • Michael C Grant, Glen J Whitman, Will J Savage, Paul M Ness, and Steven M Frank.
    • Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
    • Transfusion. 2014 Jun 1; 54 (6): 1460-8.

    BackgroundThe decision to transfuse red blood cells in surgical patients should be based on multiple clinical variables, rather than on isolated hemoglobin (Hb) measurements alone. An important but often unrecognized clinical variable is the postoperative downward drift in Hb concentration (Hb drift), but the etiology, predictors, and time course of Hb drift are not well understood.Study Design And MethodsData were retrospectively collected for patients who did not receive postoperative transfusion. Initially, 11 common surgical procedures from one institution (n=3179) were compared to assess clinical predictors of Hb drift. Data were analyzed in detail for two procedures associated with a large Hb drift (Whipple [n=82] and lumbar spinal fusion [n=74]), to determine the clinical predictors and temporal pattern of postoperative Hb drift.ResultsSurgical procedures with greater intraoperative intravenous (IV) fluid and blood requirements had greater postoperative Hb drift. The maximum Hb drifts after the Whipple and spinal fusion procedures were -2.5 ± 1.1 g/dL (occurring on Day 4, p<0.0001) and -1.8 ± 2 g/dL (on Day 3, p<0.0001), respectively. After the nadir, a 0.6 g/dL upward Hb drift (p<0.0001) occurred after both procedures, resulting in a total drift after Whipple and spinal fusion of -1.9 ± 1.2 g/dL (p<0.0001) and -1.3 ± 1.2 g/dL (p<0.0001), respectively. Type of surgery (p=0.03), intraoperative blood loss (p=0.003), and a positive perioperative fluid balance (p=0.0008) were independent predictors of Hb drift.ConclusionsPostoperative Hb drift was greater after surgical procedures with greater intraoperative IV fluid and blood requirements. Recognition of Hb drift may be an important facet of perioperative patient blood management.© 2013 American Association of Blood Banks.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.