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1998, Number 4

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Med Crit 1998; 12 (4)

Blood extraction impact in the critically ill patient

Carrillo ER, Gargallo HJJ, Durán VHC, Ramírez HJM

Language: Spanish
References: 34
Page: 130-135
PDF size: 63.85 Kb.


ABSTRACT

Objective. To evaluate the blood samples impact in the critically ill patient, and its relationship with the hemoglobin drop and transfusion requirements.
Design. Prospective clinical study.
Setting. An ICU of a tertiary care hospital of Mexico City.
Patients. Fifty patients (33 surgical patients and 17 medical patients), mean age 55 ± 19 years, APACHE II Score 18 points. All the patients with active bleeding or hemolisis during the period of study were excluded.
Interventions. Blood samples for hemoglobin determination, blood transfusions.
Measurements and principal results. Blood extraction in the fifty patients was 20.3 liters (average extraction was 67.8 mL/day), hemoglobin decreased 2 g/dL and 50 units of blood packed were administered to 26 patients.
Conclusion. Blood extraction in the ICU patient is associated with anemia, which propiates the injustified use of transfusions.


REFERENCES

  1. Chernow B. Blood conservation in critical care-the evidence accumulates. Crit Care Med 1993; 21: 481-82.

  2. Smoller BR, Kruskall MS. Phlebotomy for diagnostic laboratory tests in adults: patterns of use and effect on transfusion requirements. N Engl J Med 1986; 314: 1233-35.

  3. Foulke GE, Harlow DJ. Effective measures for reducing blood loss from diagnostic laboratory tests in intensive care unit patients. Crit Care Med 1993; 21: 481-82.

  4. Walker RH. Transfusion risks. Am J Clin Pathol 1987; 88: 374-78.

  5. Friedman BA. Patterns of blood utilization by physicians: transfusion of nonoperated anemic patients. Transfusion 1978; 18: 193-198.

  6. Goodnough LT, Johnston MF, Toy PT. The variability of transfusion practice in coronary bypass surgery. Transfusion Medicine Academic Award Group. JAMA 1991; 265: 86-90.

  7. Mozes B, Epstein M, Ben-Bassar I, Modan B, Halkin H. Evaluation of the appropriateness of blood and blood product transfusion using preset criteria. Transfusion 1989; 29: 473-6.

  8. Crowin HL, Parsonnet KC, Gettinger A. RBC transfusion in the ICU. Is there reason? CHEST 1995; 108: 767-771.

  9. Hebert C, Wells G, Marshall J et al. Transfusion requirements in critical care. JAMA 1995; 273: 1439-1444.

  10. Hebert C, Wells G, Tweeddale M et al. Does transfusion practice affect mortality in critically ill patients? Am J Respir Crit Care Med 1997; 155: 1618-1623.

  11. Allen JB, Allen FB. The minimum acceptable level of hemoglobin. Int Anesthesiol Clin 1982; 20: 1-22.

  12. Cane RD. Hemoglobin: how much is enough? Crit Care Med 1990; 18: 1046-47.

  13. Spence RK, Carson JA, Poses R et al. Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality. Am J Surg 1990; 159: 320-324.

  14. Kitchen CS. Are transfusion overrated? Surgical outcome of Jehovah’s witnesses. Am J Med 1993; 94: 117-119.

  15. Wilkerson DK, Rosen AL, Sehgal LR et al. Limits of cardiac compensation in anemic baboons. Surgery 1988; 103: 665-670.

  16. Fullerton WT, Turner AG. Exchange transfusion in treatment of severe anemia in pregnancy. Lancet 1962; 1: 75-8.

  17. Carson JL, Poses RM, Spence RK et al. Severity of anemia and operative mortality and morbidity. Lancet 1988; 1: 727-9.

  18. Gollub S, Bailey CP. Management of major surgical blood loss without transfusion. JAMA 1966; 198: 149-52.

  19. Alexiu O, Mircea N, Balaban M et al. Gastro-intestinal hemorrhage from peptic ulcer. An evaluation of bloodless transfusion and early surgery. Anesthesia 1975; 30: 609-15.

  20. Lorente JA, Landín L, De Pablo R et al. Effects of blood transfusion on oxygen transport variables in severe sepsis. Crit Care Med 1993; 21: 1312-18.

  21. Dietrich KA, Conrad SA, Hebert CA et al. Cardiovascular and metabolic response of red blood cell transfusion in critically ill volume resuscited nonsurgical patients. Crit Care Med 1990; 18: 940-44.

  22. Mink RB, Pollack MM. Effect of blood transfusion on oxygen consumption in pediatric septic shock. Abstr. Crit Care Med 1989; 17: S141.

  23. Varat MA, Adolph RJ, Flowler NO. Cardiovascular effects of anemia. Am Heart J 1972; 83: 415-26.

  24. Murray JF, Escobar E, Rapapport E. Effects of blood viscosity on hemodinamyc resonses in acute norvomolemic anemia. Am J Physiol 1969; 216: 638-42.

  25. Geha AS. Coronary and cardiovascular dynamics and oxygen availability during acute normovolemic anemia. Surgery 1976; 80:47-53.

  26. Salem-Schatz SR, Avorn J, Soumerai SB. Influence on clinical knowledge, organization context and practice style on transfusion decision making. JAMA 1991; 264: 476-83.

  27. Brien WF, Butler RJ, Inwood MJ. An audit of blood component therapy in a canadian general teaching hospital. Can Med Assoc J 1989; 140: 812-15.

  28. Coffin C, Matz K, Rich E. Algorithms for evaluating the appropiateness of blood transfussion. Transfusion 1989; 298-303.

  29. Concensus conference. Perioperative red cell transfusion. JAMA 1988; 260: 2700-3.

  30. Silberstein LE, Kruskall MS, Stheling LC et al. Strategies for the review of transfusion using preset criteria. JAMA 1989; 262: 1993-7.

  31. Peruzzi WT, Parker MA, Lichtenthal PR. A clinical evaluation of a blood conservation device in medical intensive care unit patients. Crit Care Med 1993; 21: 501-06.

  32. Silver MJ, Jubran H, Stein S et al. Evaluation of a new blood conserving arterial line system for intensive care units. Crit Care Med 1993; 21: 507-11.

  33. Zimmerman JL, Dellinger RP. Initial evaluation of a new intra-arterial blood gas system in humans. Crit Care Med 1993; 21: 495-500.

  34. Goodnough LT, Geha AS. A new era in blood conservation (editorial). Ann Thorac Surg 1991; 51: 703-4.




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