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March 1998
Evaluating Transfusion Triggers (Editorial)
Thurer RL; JAMA 1998; 279: 238-239.
No abstract available
Dr. Thurer, in his editorial focusing on both of the peer-reviewed original articles provided some historical background which comprised the basis for the conventional wisdom that perioperative patients should receive red blood cell transfusion with hemoglobin concentrations of less than 100 grams per liter (hematocrit less than 0.30).
While acknowledging that the inherent risks of transfusion have been decreased,
but nevertheless remain consequential, he also points out that the stresses
of the perioperative and postoperative process, and concomitant diseases may
increase substantially the demands on the patients for transfusion at threshold
hemoglobin concentrations greater than measured in the "normal" patients studied
by Weiskopf et al (read Dr. Watkins' review of Human
Cardiovascular and Metabolic Response to Acute, Severe Isovolemic Anemia by
Weiskopf et al and the related article Perioperative
Blood Transfusion and Postoperative Mortality by Carson et al).
The authors of both these articles as well as this editorial conclude their offerings by indicating the need for individualizing therapy for each patient, and for seeking to create more systematic clinical trials to better assess the minimal transfusion requirements of patients at various physiologic stages.
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