From the Guidelines
Transfusion of packed red blood cells (PRBCs) for blood dyscrasias should be reserved for patients with hemoglobin levels below 7-8 g/dL or those with symptomatic anemia, particularly in patients with cardiovascular compromise. When considering transfusion for blood dyscrasias, it is essential to weigh the benefits against the potential risks, including transfusion reactions, iron overload, and alloimmunization.
- The decision to transfuse should be individualized based on the patient's clinical status, rather than relying solely on laboratory values.
- Symptoms such as chest pain, dyspnea, tachycardia, or hypotension should be considered when determining the need for transfusion.
- For patients with specific conditions like myelodysplastic syndrome, thalassemia, or aplastic anemia, transfusions may be necessary to maintain adequate oxygen delivery.
- The goal of PRBC transfusion in blood dyscrasias is to relieve symptoms and improve tissue oxygenation while minimizing transfusion-related complications, as suggested by studies such as 1 and 1.
- It is also important to consider the use of iron chelation therapy for patients requiring chronic transfusions to prevent organ damage from iron accumulation, as discussed in 1.
- Recent guidelines, such as those from the Surviving Sepsis Campaign 1, recommend transfusion only when hemoglobin concentration decreases to < 7.0 g/dL in adults, in the absence of extenuating circumstances.
From the Research
Transfusion of PRBC for Blood Dyscrasia
- The decision to transfuse PRBCs in patients with blood dyscrasia should be based on the clinical condition of the patient, taking into account symptoms and co-morbidities 2.
- In cases of autoimmune hemolytic anemia (AIHA), transfusion of incompatible blood may be necessary, and the decision to transfuse should not be denied due to serological incompatibility 3.
- For patients with myelodysplastic syndromes, erythropoiesis-stimulating agents and transforming growth factor-β superfamily inhibitors may be used to promote erythropoiesis and improve anemia 4.
- When considering transfusion of PRBCs, it is essential to weigh the benefits against the risks, including the potential for adverse reactions and the impact of storage on the blood components 5.
Specific Considerations
- In patients with iron-deficiency anemia, alternative methods to improve hemoglobin levels should be tried first, and PRBC transfusion should be considered only when necessary 2.
- For patients with acute upper gastrointestinal bleeding, PRBC transfusion is recommended for hemoglobin levels less than 7 g/dL 2.
- In cases of acute coronary syndromes, the decision to transfuse PRBCs should be guided by symptoms and signs, rather than relying solely on hemoglobin levels 2.
- For patients with chronic ischemic heart disease, PRBC transfusion is recommended for hemoglobin levels less than 8 g/dL or if the patient is symptomatic 2.