Skip to main content

Part of the book series: Developments in Hematology and Immunology ((DIHI,volume 33))

  • 81 Accesses

Abstract

The “transfusion trigger” is that event or set of events which result in a patient receiving a red cell transfusion. Excellent recent discussions have been published regarding the transfusion trigger [1’4], and numerous conferences have been held to specify guidelines or algorithms whereby clinicians can make objective decisions about the use of red cells [5,6]. For many years an empirical transfusion trigger was a haemoglobin concentration of 10 g/dl. If the value was less, the patient received at least 2 units of packed red cells or whole blood, in spite of the well known fact that many patients tolerate modest anaemia quite well [7]. The rationale for such transfusions was that an O2 reserve needed to be maintained so that if unexpected (or expected) blood loss occurred during surgery, the patient would be in less danger of suffering deficient O2 delivery to tissue. Guidelines for the transfusion of blood or packed red cells in the face of severe blood loss have been less well defined.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Stehling L, Simon TL. The red blood cell transfusion trigger. Physiology and clinical studies. Arch Pathol Lab Med 1994;118:429–434.

    PubMed  CAS  Google Scholar 

  2. Goodnough LT, Verbrugge D, Vizmeg K, Riddell 4th J. Identifying elective orthopedic surgical patients transfused with amounts of blood in excess of need: the transfusion trigger revisited. Transfusion 1992; 32:648–653.

    Article  PubMed  CAS  Google Scholar 

  3. Levine E, Rosen A, Sehgal L, Gould S, Sehgal H, Moss G. Physiologic effects of acute anaemia: implications for a reduced transfusion trigger. Transfusion 1990;30: 11–14.

    Article  PubMed  CAS  Google Scholar 

  4. Greenburg, AG. A physiologic basis for red blood cell transfusion decisions. Am J Surg 1995;70(6A suppl):44S–48S.

    Article  Google Scholar 

  5. Robertie PG, Gravlee GP. Safe limits of isovolemic haemodilution and recommendations for erythrocyte transfusion. Int Anesth Clin 1990;28:197–204.

    Article  CAS  Google Scholar 

  6. NIH Consensus Conference. Perioperative Red Cell Transfusion. JAMA 1988;260: 2700–2703.

    Article  Google Scholar 

  7. Mollison PL. Blood transfusion in clinical medicine. 7th ed. Philadelphia: FA Davis, 1983.

    Google Scholar 

  8. Schreiber GB, MP Busch, SH Kleimnan, JJ Kovelitz, for the Retrovirus Epidemiology Donor Study. The risk of transfusion-transmitted viral infection. N Engl J Med 1996;34:1685–1690.

    Article  Google Scholar 

  9. Winslow, R.M. In: Rudolph AS, Rabinovici, R, Feuerstein, GZ (eds). Red Blood Cell Substitutes. New York: Marcel Dekker, 1998:37–38.

    Google Scholar 

  10. Baele PL, De Bruyere M, Deneys V, et al. The SANGUIS Study in Belgium: an overview. Acta Chir Belg 1994;94:69–74.

    PubMed  CAS  Google Scholar 

  11. Friedman BA, Bums TL, Schork MA. An analysis of blood transfusion of surgical patients by sex: a question for the transfusion trigger. Transfusion 1980;20:179–188.

    Article  PubMed  CAS  Google Scholar 

  12. Wilkerson DK, Rosen AL, Sehgal LR, Gould SA, Sehgal HL, Moss GS. Limits of cardiac compensation in anemic baboons. Surgery 1988; 103:666–670.

    Google Scholar 

  13. Cain SM. Oxygen delivery and uptake in dogs during anemic and hypoxic hypoxia. J Appl Physiol 1977; 42:228–234.

    PubMed  CAS  Google Scholar 

  14. Kitchens CS. Are transfusions overrated? Surgical outcome of Jehovah’s Witnesses. Am J Med 1993;94:117–119.

    Article  PubMed  CAS  Google Scholar 

  15. Spahn DR, Smith LR, Veronee CD, et al. Acute isovolemic haemodilution and blood transfusion. Effects on reg function and metabolism in myocardium with compromised coronary blood flow. J Thorac Cardiovasc Surg 1993; 105:694–704.

    PubMed  CAS  Google Scholar 

  16. Levy PS, Kim SJ, Eckel PK, et al. Limit to cardiac compensation during acute isovolemic haemodilution: influence of coronary stenosis. Am J Physiol 1993;265: H340–H349.

    PubMed  CAS  Google Scholar 

  17. Christopherson R, Frank S, Norris E, Rock P, Gottlieb S, Beattie C. Low postoperative haematocrit is associated with cardiac ischemia in high-risk patients. Anesthesiology 1991;75(3A):A99.

    Article  Google Scholar 

  18. Nelson AH, Fleisher LA, Rosenbaum SH. Relationship between postoperative anaemia and cardiac morbidity in high risk vascular patients in the intensive care unit. Crit Care Med 1993;210:860–866.

    Article  Google Scholar 

  19. Johnson RG, Thurer RL, Kruskall MS, et al. Comparison of two transfusion strategies after elective operations for myocardial revascularization. J Thorac Cardiovasc Surg 1992;104:307–314.

    PubMed  CAS  Google Scholar 

  20. Dick W, Baur C, Reiff K. Which factors determine the critical haematocrit as an indication of transfusion? Anaesthesist 1992;41:1–14.

    PubMed  CAS  Google Scholar 

  21. Wisner DH, Holcroft JW. Surgical critical care. Curr Prob Surg 1990;27:467–469.

    Article  Google Scholar 

  22. Meyers RL, Paulick R-P, Rudolph CD, Rudolph AM. Cardiovascular responses to acute, severe haemorrhage in fetal sheep. J Dev Physiol 1991; 15:189–197.

    PubMed  CAS  Google Scholar 

  23. Ping Wang ZF, Ba M-CL, Ayala A, Harkema JM, Chaudry IH. Measurement of circulating blood volume in vivo after trauma-haemorrhage and haemodilution. Am J Physiol 1994;266:R368–R374.

    PubMed  CAS  Google Scholar 

  24. Guyton AC, Jones CE, Coleman TG. Cardiac output and its regulation. 2nd ed. Philadelphia: Saunders, 1973.

    Google Scholar 

  25. Wasserman K, Hansen JE, Sue DY. Facilitation of oxygen consumption by lactic acidosis during exercise. News in Physiological Science 1991;6:29–34.

    Google Scholar 

  26. Mitzner W, Goldberg HS, Lichenstein S. Effects of thoracic blood volume changes on steady state cardiac output. Circ Res 1976;38:255–261.

    Article  PubMed  CAS  Google Scholar 

  27. Saxena S, Rabinowitz AP, Johnson C, Shulman IA. Iron-deficiency anaemia: a medically treatable chronic anaemia as a model for transfusion overuse. Am J Med 1993; 94:120–124.

    Article  PubMed  CAS  Google Scholar 

  28. Stehling L, Zauder HL. Acute normovolemic haemodilution. Transfusion 1991;31: 857–868.

    Article  PubMed  CAS  Google Scholar 

  29. Viele MK, Weiskopf RB. What can we learn about the need for transfusion from patients who refuse blood? The experience with Jehovah’s witnesses. Transfusion 1994;34:396–401.

    Article  PubMed  CAS  Google Scholar 

  30. Polley JW, Berkowitz RA, McDonald TB, Cohen M, Figueroa A, Penney DW. Craniomaxillofacial surgery in the Jehovah’s Witness patient. Plast Reconstr Surg 1994;93(6):1258–1263.

    Article  PubMed  CAS  Google Scholar 

  31. Marelli TR. Use of a haemoglobin substitute in the anemic Jehovah’s Witness patient. Crit Care Nurse 1994;February:31–38.

    Google Scholar 

  32. Newton CR, Marsh K, Peshu N, Mwangi I. Blood transfusions for severe anaemia in African children. Lancet 1992;340:916–917.

    Article  Google Scholar 

  33. Faust RJ. Perioperative indications for red blood cell transfusion: has the pendulum swung too far? Mayo Clinic Proc 1993;68:512–514.

    CAS  Google Scholar 

  34. Winslow RM, Monge CC. Hypoxia, polycythemia, and chronic mountain sickness. Baltimore: Johns Hopkins University Press, 1987.

    Google Scholar 

  35. Crowell JW, Smith EE. Determination of the optimal haematocrit. J Appl Physiol 1967;22(3):501–504.

    PubMed  CAS  Google Scholar 

  36. Roughton FJW, Forster RE. Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human with special reference to true diffusing capacity of pulmonary. J Appl Physiol 1957;11:290–302.

    PubMed  CAS  Google Scholar 

  37. Heliums JD. The resistance to oxygen transport in the capillaries relative to that in the surrounding tissue. Microvasc Res 1995; 13; 131–145.

    Article  Google Scholar 

  38. Winslow RM. A model for red cell O2 uptake. Int J Clin Monit Comput 1985;2:81–93.

    Article  PubMed  CAS  Google Scholar 

  39. Shephard AP, Granger HJ, Smith EE, Guyton AC. Local control of tissue oxygen delivery and its contribution to the regulation of cardiac output. Am J Physiol 1973;225:747–755.

    Google Scholar 

  40. Cordts PR, LaMonte WW, Fisher JB, et al. Poor predictive value of haematocrit and haemodynamic parameters for erythrocyte deficits after extensive elective vascular operations. Surg Gynec Obstet 1992; 175:243–248.

    PubMed  CAS  Google Scholar 

  41. Kim DA, Brecher ME, Estes TJ, Morrey BF. Relationship of haemoglobin and duration of hospitalization after total hip arthroplasty: implications for the transfusion target. Mayo Clinic Proc 1993;68:37–41.

    CAS  Google Scholar 

  42. Carson JL, Spence RK, Poses RM, Bonavita G. Severity of anaemia and operative mortality and morbidity. Lancet 1988;l:727–729.

    Google Scholar 

  43. Piiper J, Meyer M, Scheid P. Dual role of diffusion in tissue gas exchange: blood-tissue equilibration and diffusion shunt. Respir Physiol 1984;56:131–144.

    Article  PubMed  CAS  Google Scholar 

  44. Tenney SM. A theoretical analysis of the relationships between venous blood and mean tissue oxygen pressures. Respir Physiol 1974;20:238–296.

    Article  Google Scholar 

  45. Gould SA, Rosen AL, Sehgal LR, et al. O2 extraction ratio: A physiologic indicator of transfusion need [Abstract]. Transfusion 1983;23:S416.

    Google Scholar 

  46. Spiess BD, Tuman KJ, McCarthy RJ, et al. Oxygen consumption and mixed venous oxygen saturation monitoring during orthotopic liver transplantation. J Clin Monit 1992;8:7–11.

    Article  PubMed  CAS  Google Scholar 

  47. Hoppeler YH, Noti C, Gurtner HP, et al. Limitations to VO2max in humans after blood retransfusion. Respir Physiol 1993; 92:329–341.

    Article  PubMed  Google Scholar 

  48. Yu M, Levy MM, Smith P, Takiguchi SA, Miyasaki A, Myers SA. Effect of maximizing oxygen delivery on morbidity and mortality rate in critically ill patients: a prospective, randomized, controlled study. Crit Care Med 1993;21:830–838.

    Article  PubMed  CAS  Google Scholar 

  49. Slanetz PJ, Lee R, Page R, Jacobs Jr EE, LaRaia PJ, Vlahakes GJ. Haemoglobin blood substitutes in extended preoperative autologous blood donation: an experimental study. Surgery 1994; 115:246–254.

    PubMed  CAS  Google Scholar 

  50. Cain SM, Curtis SE. Experimental models of pathological oxygen supply dependency. Crit Care Med 1991;19:603–612.

    Article  PubMed  CAS  Google Scholar 

  51. Cain SM. Assessment of tissue oxygénation. Crit Care Clin 1986;2:537–550.

    PubMed  CAS  Google Scholar 

  52. Mink RB, Pollack MM. Effect of blood transfusion on oxygen consumption in pediatric septic shock. Crit Care Med 1990;18:1087–1091.

    Article  PubMed  CAS  Google Scholar 

  53. Lorente JA, Landin L, De Pablo R, Renes E, Rodriguez-Diaz R, Liste D. Effects of blood transfusion on oxygen transport variables in severe sepsis. Crit Care Med 1993;21:1312–1318.

    Article  PubMed  CAS  Google Scholar 

  54. Seear M, Wensley D, MacNab A. Oxygen consumption-oxygen delivery relationship in children. J Pediatr 1993; 123:208–214.

    Article  PubMed  CAS  Google Scholar 

  55. Silverman HJ, Tuma P. Gastric tonometry in patients with sepsis. Effects of dobutamine infusions and packed red blood cell transfusions. Chest 1992; 102:184–188.

    Article  PubMed  CAS  Google Scholar 

  56. Hanique G, Dugemier T, Laterre PF, Dougnac A, Roeseler J, Reynaert MS. Significance of pathologic oxygen supply dependency in critically ill patients: comparison between measured and calculated methods. Intensive Care Med 1994;20:12–18.

    Article  PubMed  CAS  Google Scholar 

  57. Lucking SE, Williams TM, Chaten FC, Metz RI, Mickell JJ. Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction. Crit Care Med 1990;18:1316–1319.

    Article  PubMed  CAS  Google Scholar 

  58. Marik PE, Sibbald WJ. Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993; 269:3024–3029.

    Article  PubMed  CAS  Google Scholar 

  59. Steffes CP, Bender JS, Levison MA. Blood transfusion and oxygen consumption in surgical sepsis. Crit Care Med 1991; 19:512–517.

    Article  PubMed  CAS  Google Scholar 

  60. Silverman HJ. Lack of a relationship between induced changes in oxygen consumption and changes in lactate levels. Chest 1991; 100:1012–1015.

    Article  PubMed  CAS  Google Scholar 

  61. Conrad SA, Dietrich KA, Hebert CA, Romero MD. Effect of red cell transfusion on oxygen consumption following fluid resuscitation in septic shock. Circ Shock 1990; 31:419–429.

    PubMed  CAS  Google Scholar 

  62. Ronco JJ, Phang PT, Walley KR, Wiggs B, Fenwick JC, Russell JA. Oxygen consumption is independent of changes in oxygen delivery in adult respiratory distress syndrome. Am Rev Respir Dis 1991; 143:1267–1273.

    PubMed  CAS  Google Scholar 

  63. Ronco JJ, Montaner JS, Fenwick JC, Russell JA. Pathologic dependence of oxygen consumption on oxygen delivery in respiratory failure secondary to AIDS-related Pneumocystis carinii pneumonia. Chest 1990;98:1463–1466.

    Article  PubMed  CAS  Google Scholar 

  64. Babineau TJ, Dzik VM, Borlase BC, Baxter JK, Bistrian BR, Benotti PN. Reevaluation of current transfusion practices in patients in surgical intensive care units. Am J Surg 1992; 164:22–25.

    Article  PubMed  CAS  Google Scholar 

  65. Levy PS, Chavez RP, Crystal GJ, et al. Oxygen extraction ratio: a valid indicator of transfusion need in 1 coronary vascular reserve? J Traum 1992;32:769–773; discussion, 773-74.

    Article  CAS  Google Scholar 

  66. Wilkerson DK, Rosen AL, Gould SA, Sehgal LR, Sehgal HL, Moss GS. Whole body oxygen extraction ratio as an indicator of cardiac status in anaemia. Current Surgery 1988;45:214–217.

    PubMed  CAS  Google Scholar 

  67. Mathru M, Kleinman B, Blakeman B, Sullivan H, Kumar P, Dries DJ. Myocardial metabolism and adaptation during extreme haemodilution in humans after coronary revascularization. Crit Care Med 1992;20:1420–1425.

    Article  PubMed  CAS  Google Scholar 

  68. Dietrich KA, Conrad SA, Hebert CA, Levy GL, Romero MD. Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 1990; 18:940–944.

    Article  PubMed  CAS  Google Scholar 

  69. Thompson CH, Kemp GJ, Taylor DJ, Ledingham JG, Radda GK, Rajagopalan B. No effect of blood transfusion on muscle metabolism. Q J Med 1992;85:897–899.

    PubMed  CAS  Google Scholar 

  70. Jonsson K., Jensen JA, Goodson VM, et al. Tissue oxygénation, anaemia, and perfusion in relation to wound healing in surgical patients. Ann Surg 1991;214:605–613.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Winslow, R.M. (1998). The Role of O2 Transport in the Development of the Transfusion Trigger. In: Sibinga, C.T.S., Das, P.C., Fratantoni, J.C. (eds) Alternative Approaches to Human Blood Resources in Clinical Practice. Developments in Hematology and Immunology, vol 33. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5619-0_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-5619-0_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7571-5

  • Online ISBN: 978-1-4615-5619-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics