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Indications for Blood Transfusion:

- Blood Product Menu:
      - pRBCs / Fresh Frozen Plasma / Platlets / Cryoprecipitate / Transfusion Therapy / Coag Pathway

- Discussion:
    - The 1988 NIH Consensus Conference on Perioperative Red Blood Cell Transfusions suggested that no single criterion should be
           used as an indication for red cell component therapy and that multiple factors related to the patient's clinical status and oxygen
           delivery needs should be considered.” 
    - w/ severe anemia, there will be increase in the lactate levels and the oxygen extraction ratio >50%;
    - specific indications: 
           - needs to evaluate the risk-benefit ratio of transfusion
           - there are no reliable parameters to decide on when to transfuse, especially when Hgb 7-10g/dl.
           - consider:
                 - ability to compensate for anemia
                 - rate of ongoing blood loss;
                 - likelihood of further blood loss
                 - evidence of end-organ compromise
                 - risk of CAD
           - references:
                 - Guidelines for the clinical use of red cell transfusions.
                 - Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies
                 - Practice Guidelines for Blood Transfusion. American Red Cross. 2007
                 - Indications for perioperative blood transfusion in orthopedic surgery

- Clinical Value of Transfusion:
    - in the report by Wu WC, et al, studied in the effects of blood transfusion in patient experiencing MI;
          - retrospective study of data on 78,974 Medicare beneficiaries 65 years old or older who were hospitalized with acute MI;
          - patients were categorized according to the hematocrit on admission (5.0 to 24.0 %, 24.1 to 27.0 %, 27.1 to 30.0 %, 30.1 to 33.0 %, 33.1 to 36.0 %, 36.1 to 39.0 %, or 39.1 to 48.0 %), and data were evaluated to determine whether there was an association between use of transfusion and 30-day mortality.
          - patients with lower hematocrit values on admission had higher 30-day mortality rates;
          - blood transfusion was associated with a reduction in 30-day mortality among patients whose Hct on admission fell into the categories ranging from 5.0 to 24.0 % to 30.1 to 33.0 %;
          - ref: Blood transfusion in elderly patients with acute myocardial infarction.

- Predicting the Need for Transfusion in Orthopaedic Patients:
    - preoperative hemoglobin is main indicator for need of postoperative transfusion;
    - preoperative Hgb less than 11 g/dl is a strong indicator for need for transfusion in total joint replacement;
          - in the report by Salido JA, et al (2002), authors studied risk factors for transfusion in patient undergoing joint replacement;
                 - patients with a preoperative hemoglobin level of <130 g/L had a four times greater risk of having a transfusion than did those with a hemoglobin level between 130 and 150 g/L and a 15.3 times greater risk than did those with a hemoglobin level of >150 g/L;
                 - preop Hg level (p = 0.0001) and weight of the patient (p = 0.011) were shown to predict the need for blood transfusion after TJR.;
          - ref: Preoperative Hgb Levels and the Need for Transfusion After Prosthetic Hip and Knee Surgery: Analysis of Predictive Factors
    - in the report by Hatzidakis AM, et al (2000), the authors studied the role of transfusion in 247 TKR (157 unilateral primary,
            32 revision, and twenty-nine one-stage bilateral primary procedures) and 271 total hip replacements;
            - they found that patients who have an initial hg level of at least 150 grams per liter or an initial hemoglobin level of between 130 and 150 grams per liter and an age of less than sixty-five years have a minimal risk of needing a transfusion during or after a primary total joint replacement.
    - references:
            - Preoperative autologous donation for total joint arthroplasty. An analysis of risk factors for allogenic transfusion.
            - Blood management experience: relationship between autologous blood donation and transfusion in orthopedic surgery.

- References:
     - Outcome of massive transfusion exceeding two blood volumes in trauma and emergency surgery.
     - Severity of anaemia and operative mortality and morbidity.
     - Limits of cardiac compensation in anemic baboons.
     - Oxygen extraction ratio: a valid indicator of myocardial metabolism in anemia.
     - Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality.
     - Relationship between postoperative anemia and cardiac morbidity in high-risk vascular patients in the intensive care unit.