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• The decision whether to transfuse should be based on the patient’s current and
predicted need for additional oxygen-carrying capacity
• First, it is important to determine whether significant hypovolemia or active
bleeding is present.
• In such patients, liberal transfusion is indicated as a means of increas- ing
intravascular volume and preventing the development of profound deficits in
oxygen-carrying capacity
APPROACH TO THE PATIENT WITH ANEMIA
Symptomatic Anemia
• An additional consideration in the decision to transfuse blood is the oxygen-carrying
capacity that is necessary to prevent patient fatigue or discomfort.
• Typical symptoms of anemia include lightheadedness, tachycardia, and tachypnea
either during activity or at rest.
• The key judgment to make in deciding whether to treat symptomatic anemia with
transfusion is whether the anemia is truly compromising the patient’s health or
recovery.
APPROACH TO THE PATIENT WITH ANEMIA
Observation of Anemia
• Reviews of patients suggest that a hemoglobin below 5 g/dL results in
substantial increases in mortality, especially in elderly persons and patients
with cardiovascular disease.
• When RBC transfusion is not possible a number of temporizing measures can
be used
APPROACH TO THE PATIENT WITH ANEMIA
Observation of Anemia
• First, steps should be taken to minimize additional iatrogenic blood loss. Laboratory tests should be
restricted to those that are most likely to benefit the patient and should be conducted with the
smallest amount of blood possible
• Second, any impediments to native erythropoiesis should be removed: iron should be supplemented
(orally if possible), and the administration of recombinant erythropoietin should be considered.
• Third, 100% oxygen should be administered because oxygen dissolved in plasma contributes a
significant proportion of oxygen delivery at very low hemoglobin levels.
• Fourth, in extreme cases, consideration should be given to decreasing oxygen demand