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current inotropes, vasopressors, or anti-hypertensives (if any)

Transfusion of Packed RBC’s

The principle objective when giving PRBC’s is the improvement of inadequate oxygen delivery and the minimization of adverse outcomes as a result of this. In a patient who is actively bleeding and thus who’s hemoglobin mass is not in a steady state, one must be more liberal in transfusing PRBC’s to avoid severe impairments in peripheral oxygen delivery. However, with a patient who is not bleeding rapidly, one can take a more deliberate approach to transfusion.

Remember that there are several potential risks associated with the transfusion of red blood cells, including

  1. Transfusion reactions (hemolytic, non-hemolytic, febrile)
  2. Infections (hepatitis B, C, etc.; CMV, bacterial, parasitic)
  3. Immunosuppression (increased sepsis)

The use of a single Hgb trigger for all patients, and other approaches that fail to consider all important physiologic and surgical factors affecting oxygenation are not recommended. The risk of complications from inadequate O2 delivery should determine the need for transfusion. Signs of inadequate oxygen delivery include a low mixed venous oxygen saturation, high lactic acid level, or clinical signs of organ dysfunction that cannot be attributed to other causes. Most post-operative cardiac patients, who are hemodynamically stable, are not actively bleeding, and are following an otherwise uncomplicated post-operative course, tolerate a Hgb as low as 7.0 g/dL without problems.