Transfusion Triggers

  • L. T. Goodnough
Conference paper


The therapeutic goal of a blood transfusion is to improve oxygen delivery (DO2) and consumption (VO2) according to the physiologic need of the recipient. The usual response to an acute reduction in hemoglobin concentration in the normovolemic state is to increase cardiac output to maintain adequate DO2 [1] (Fig. 1). The heart is, therefore, the principal organ at risk in acute anemia. Myocardial anaerobic metabolism, indicating inadequate DO2, occurs when lactate metabolism in the heart converts from lactate uptake to lactate production. The normal whole-body oxygen-extraction ratio (O2ER, the ratio of VO2 to DO2) is 20 to 25%. The O2ER approaches 50% when myocardial lactate production occurs, indicating anaerobic metabolism. In a normal heart, this lactate production and an O2ER of 50% occur at a hemoglobin concentration of approximately 3.5–4 g/dl [2]. In a model of coronary stenosis, the anaerobic state occured at a hemoglobin concentration of approximately 6–7 g/dl [3]. No single number, either extraction ratio or hemoglobin concentration, can serve as an absolute indicator of transfusion need. However, the use of such a physiologic value in conjunction with clinical assessment of the patient’s status permits a rational decision regarding the appropriateness of transfusion prior to the onset of hypoxia or ischemia [4].


Hemoglobin Concentration Transfusion Threshold Acute Anemia Acute Normovolemic Hemodilution Improve Oxygen Delivery 
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© Springer-Verlag Berlin Heidelberg 2003

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  • L. T. Goodnough

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