Abstract
Anemia and red blood cell (RBC) transfusion occur frequently in hospitalized patients with cardiac disease. In this narrative review, we report the epidemiology of anemia and RBC transfusion in hospitalized adults and children (excluding premature neonates) with cardiac disease, and on the outcome of anemic and transfused cardiac patients. Both anemia and RBC transfusion are common in cardiac patients, and both are associated with mortality. RBC transfusion is the only way to rapidly treat severe anemia, but is not completely safe. In addition to hemoglobin (Hb) concentration, the determinant(s) that should drive a practitioner to prescribe a RBC transfusion to cardiac patients are currently unclear. In stable acyanotic cardiac patients, Hb level above 70 g/L in children and above 70 to 80 g/L in adults appears safe. In cyanotic children, Hb level above 90 g/L appears safe. The appropriate threshold Hb level for unstable cardiac patients and for children younger than 28 days is unknown. The optimal transfusion strategy in cardiac patients is not well characterized. The threshold at which the risk of anemia outweighs the risk of transfusion is not known. More studies are needed to determine when RBC transfusion is indicated in hospitalized patients with cardiac disease.
Highlights
Red blood cell (RBC) transfusion is common in critically ill adults and children [1,2,3]
A retrospective descriptive epidemiological study of 78,974 patients older than 65 years with acute myocardial infarction showed that RBC transfusion was associated with a lower risk of 30-day mortality if hematocrit was below 24% (odds ratio (OR): 0.22; 95% confidence interval (CI): 0.11 to 0.45) or between 30% and 33% (OR: 0.69; 95% CI: 0.53 to 0.89), but not in cardiac patients with hematocrit above 33% [46]
Anemia is common in patients with cardiac disease and is associated with mortality and morbidity
Summary
Red blood cell (RBC) transfusion is common in critically ill adults and children [1,2,3]. Rao et al [43] published a descriptive epidemiological study on 24,112 patients with acute coronary syndrome who were enrolled in three large randomized controlled trials (RCTs) They compared the outcomes of those who received at least one RBC transfusion (n = 21,711) and those who did not (n = 2,401); RBC transfusion was associated with an increased HR for 30-day mortality (HR = 3.94; 95% CI: 3.26 to 4.75). Confronted with the risks of transfusion and a growing body of literature associating RBC transfusion with adverse outcomes, a number of RCTs have compared the safety of adopting a restrictive versus liberal RBC transfusion strategy (low versus higher threshold Hb) in critically ill patients with cardiac disease (Table 3). Further clinical studies are required before a given goal that would help practitioners to precisely decide when to transfuse cardiac patients can be recommended in this population
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