More and more data is coming in recent times about hazards of blood transfusion. In a
landmark TRICC1 trial Euvolemic patients in the intensive care unit (ICU) with Hb<9 g/dl were
randomized to a restrictive transfusion strategy for transfusion of PRBCs (transfused if Hb<7 g/dl
to maintain Hb between 7 and 9 g/dl) or a liberal strategy (transfused if Hb<10 g/dl to maintain Hb
10-12 g/dl). Mortality was similar in both groups, indicating that liberal transfusions were not
beneficial. An Updated Report by the American Society of AnaesthesiologistsTask Force on
Perioperative Blood Management tells us restrictive red blood cell transfusion strategy may be
safely used to reduce transfusion administration. It further states that The determination of
whether hemoglobin concentrations between 6 and 10 g/dl justify or require red blood cell
transfusion should be based on potential or actual on going bleeding (rate and magnitude),
intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve.
Should we extrapolate these guidelines in Cardiac surgery? TRACS2 trial concluded that
among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion
strategy compared with a more liberal strategy resulted in noninferior rates of the combined
outcome of 30-day all-cause mortality and severe morbidity.They advocated use of restrictive
strategy, but 5 years later, the authors 3concluded that A restrictive transfusion threshold after
cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care
costs.
With this conflicting evidence, by which way anaesthesiologist to go?
BLOOD TRANSFUSION IN CARDIAC SURGERY- NEED TO FOLLOW BASICS!
