Transfusion therapy

Current guidelines regarding red cell transfusions require consideration of the rate of blood loss, the hematocrit level, and hemodynamic parameters such as mean arterial pressure, cardiac index, and mixed venous oxygen saturation. The old 10/30 rule, i.e. an arbitrary decision to transfuse patients when the hemoglobin is below 10 g/dl (or hematocrit below 0.30), is now regarded as inappropriate because hemoglobin concentration is a poor clinical indicator of tissue oxygen delivery. Transfusion is rarely indicated when the hemoglobin concentration exceeds 10 g/dl and is almost always indicated when it is less than 6 g/dl, particularly when the anemia is acute. The decision as to whether intermediate hemoglobin concentrations (6-10 g/dl) justify red blood cell transfusions should be based on the patient's risk of developing complications arising from inadequate oxygenation. Those with transfusion needs at a relatively high hemoglobin level include patients with or at high risk of developing myocardial ischemia and those with cerebral vascular or peripheral circulatory disease.

Except in life-threatening situations with ongoing massive hemorrhage, intravascular volume should be normalized by crystalloid and colloid solutions before transfusion decisions are made. When transfusion is initiated, a 'unit-by-unit basis' approach is mandatory, with evaluation after each unit. Transfusion of one unit of blood in a non-bleeding adult increases hematocrit by approximately 3 per cent and hemoglobin concentration by 1 g/dl.

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Sleep Apnea

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