Hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery

Abstract

Although red blood cells (RBCs) transfusion is sometimes associated with adverse reactions, anemia could also lead to increased morbidity and mortality in high-risk patients. For these reasons, the definition of perioperative strategies that aims to detect and treat preoperative anemia, prevent excessive blood loss, and define “optimal” transfusion algorithms is crucial. Although the treatment with preoperative iron and erythropoietin has been recommended in some specific conditions, several controversies exist regarding the benefit-to-risk balance associated with these treatments. Further studies are needed to better define the indications, dosage, and route of administration for preoperative iron with or without erythropoietin supplementation. Although restrictive transfusion strategies in patients undergoing cardiac surgery have been shown to effectively reduce the incidence and the amount of RBCs transfusion without increase in side effects, some high-risk patients (e.g., symptomatic acute coronary syndrome) could benefit from higher hemoglobin concentrations. Despite all efforts made last decade, a significant amount of work remains to be done to improve hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery.

Keywords: Cardiac surgery; Blood transfusion; Anemia; Transfusion threshold; Risk factor

Core tip: Anemia and red blood cells transfusion are common during cardiac surgery, and could be associated with adverse reactions. Preoperative hemoglobin optimization through the identification and treatment of anemia and the definition of standardized transfusion algorithm using restrictive transfusion triggers play a central role in the development of Patient Blood Management programs. However, further researches are needed to better define transfusion triggers, based on pathophysiological indices, rather than single hemoglobin thresholds.