Current opinion in hematology
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Curr. Opin. Hematol. · Nov 2013
ReviewRed blood cell transfusion: what is the evidence when to transfuse?
This review provides a summary of the clinical trials evaluating transfusion thresholds and recommendations for red blood cell transfusion. We highlight the trial results in patients in the critical care setting, undergoing surgery, and patients with gastrointestinal bleed, acute coronary syndrome, and acute brain injury. ⋯ A restrictive transfusion strategy of administering red blood cell transfusion in patients with hemoglobin concentration of 7-8 g/dl in most patients is supported by randomized clinical trials. Further randomized clinical trials are needed to establish the optimal transfusion threshold in patients with acute coronary syndrome and brain injury, and to elucidate physiological triggers.
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This review examines the recent research on the prevalence, determinants and importance of low iron in blood donors, and on the efforts to reduce or prevent iron depletion in donor populations. ⋯ Although the impact of phlebotomy-related iron depletion on donor health requires better documentation, measures are available now that can be deployed on a targeted or standardized basis. Blood centers, regulators, and donors should continue to evaluate different approaches for addressing this problem, with the likely outcome that no single measure is optimal for maintaining adequate collections while safeguarding donor health.
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Possible adverse effects of prolonged storage of red blood cell concentrates (RBCs) are being formally assessed both by observational studies and in randomized controlled trials. New mechanisms have been put forth to explain earlier conflicting observations. This review summarizes ongoing investigations into clinical and basic science studies on RBC storage effects. ⋯ We still do not know whether older red cells have adverse effects, and if so, what determines such clinical effects after transfusion of 'old' RBCs. RBC production factors, previously seldom reported, may play an important role and should be reported.
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This review will address recent developments in the transfusion management of massively transfused trauma patients, focusing on the use of fixed blood component ratios in massive transfusion protocols. ⋯ Massive transfusion protocols with fixed ratios of red blood cells to plasma and platelets have improved survival in both civilian and military trauma patients. Continued studies of ratios as well as integration of other therapies and testing are ongoing in order to continue to improve patient outcome.