Is there an optimal hemoglobin value in the cardiac intensive care unit?

Ronald S. Freudenberger, Jeffrey L. Carson

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations

Abstract

Anemia is common in patients admitted to the cardiac intensive care unit. Many unique issues must be considered in the treatment of the anemic cardiac patient. Coronary artery disease and left ventricular dysfunction may significantly increase the risk of anemia. These patients have limited reserve because of a high extraction ratio of oxygen in the cardiac circulation. Left ventricular dysfunction increases the risk of complications from transfusion. Recent observational studies suggest that cardiac patients may benefit from a higher transfusion threshold. However, very few patients with cardiovascular disease have been included in clinical trials comparing high and low transfusion triggers. Experimental data and recent studies in humans suggest that cardiac patients may be intolerant of anemia. Pending definitive clinical trials in cardiac patients, we suggest a more aggressive transfusion trigger (9-1 0 g/dL) in patients with active cardiac disease. Pulmonary edema may be precipitated by transfusion in patients with left ventricular dysfunction. Large clinical trials are urgently needed to determine optimal transfusion thresholds in patients with cardiovascular disease.

Original languageEnglish (US)
Pages (from-to)356-361
Number of pages6
JournalCurrent Opinion in Critical Care
Volume9
Issue number5
DOIs
StatePublished - Oct 2003

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

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