Blood transfusion in cardiac surgeries - Toward a personalized protocol

• Published in: The American journal of surgery Vol. 227; pp. 237 - 238
• Main Authors: Min, Yan, Dalal, Alex R, Pedroza, Albert J, Pham, Tho D, Panigrahi, Anil K, Goldstone, Andrew B, MacArthur, John W, Woo, Y Joseph, Baiocchi, Michael, Fischbein, Michael P
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.01.2024
• Subjects: Anesthesia; Blood; Blood Transfusion; Blood transfusions; Cardiac Surgical Procedures; Clinical trials; Customization; Diabetes; Females; Guidelines; Hemoglobin; Humans; Lung diseases; Males; Patients; Surgery; Transfusion
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2023.07.035

[...]leveraging the empirical results of these randomized trials, modern surgical and anesthesia task force recommendations have focused on static, one-size-fits-all transfusion triggers,4 including the 2021 STS/SCA/AmSECT/SABM updated patient blood management guidelines.5 However, transfusion policies utilizing a static, one-size-fits-all threshold may overlook individual characteristics that correlate with patients’ HGB level and result in unnecessary transfusions for patients. [...]a recent retrospective study showed females undergoing surgical procedures are at an increased blood transfusion risk despite adjusting for height and weight.6 However, truly personalized transfusion protocols (e.g., accounting for a patient's HGB baseline and tolerance to blood loss) have not been investigated in any randomized clinical trials. [...]current guidelines are built on studies that only consider one-size-fits all approaches. Male HGB on average is 1.65 g/dL (Confidence Interval: 1.62–1.69) higher than that of female's, a difference equivalent to at least 1.5 units of packed RBC transfusion, assuming a standard 1 g/dL increase in HGB per unit in a 70kg patient.