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Ann Thorac Surg 2006;82:2323-2334
© 2006 The Society of Thoracic Surgeons

Reviews

Indications for Blood Transfusion in Cardiac Surgery

Gavin J. Murphy, MD, FRCS*, Gianni D. Angelini, MD, FRCS

Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom

Accepted for publication June 12, 2006.

* Address correspondence to Dr Murphy, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom (Email: gavinmurphy{at}bristol.ac.uk).

In addition to its life-saving effect in hemorrhagic shock, transfusion of allogenic packed red blood cells can be beneficial in situations where a critically low hematocrit is contributing to a state of oxygen-supply dependency. These benefits are countered by the risks of transfusion-associated lung injury, transfusion-associated immunomodulation, and cellular hypoxia after RBC transfusion. The critical hematocrit is patient and organ specific, and varies intraoperatively according to the duration and temperature of bypass, as well as for a variable postoperative period. Future randomized studies must prospectively evaluate regional indicators of tissue oxygenation in transfusion algorithms.




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