PRBC Transfusion Threshold for Patients with Cardiac Disease
As previously discussed, the PRBC transfusion threshold for the general population of critically ill patients is a Hgb < 7 gm/dL.
Traditional teaching has been to maintain a Hgb > 10 gm/dL in patients with a history of CAD.
This threshold stems from a 1950s cohort of Jehovah's Witness patients, and several observational studies, that demonstrated increased perioperative mortality in patients whose Hgb was < 10 gm/dL.
Recent studies, however, have found that patients with a history of CAD tolerate lower Hgb levels without increases in morbidity or mortality. In fact, current cardiovascular surgery guidelines favor a conservative Hgb threshold (7 gm/dL) for patients with CAD.
Importantly, the Hgb threshold of < 7 gm/dL for PRBC transfusion applies to patients with simply a history of CAD and not to patients with evidence of an acute coronary syndrome (STEMI, NSTEMI, unstable angina). Guidelines continue to recommend a Hgb > 10 gm/dL for patients with ACS.
References
Netzer G, Hess JR, Shanholtz C. Use of blood products in the intensive care unit: Concepts and controversies. Contemporary Critical Care June 2010;8(1):1-12.
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