The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery

Keyvan Karkouti

From the Department of Anesthesia; the Department of Health Policy, Management, and Evaluation; and the Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.

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Duminda N. Wijeysundera,

Duminda N. Wijeysundera

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Terrence M. Yau,

Terrence M. Yau

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Stuart A. McCluskey,

Stuart A. McCluskey

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Adriaan Van Rensburg,

Adriaan Van Rensburg

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W. Scott Beattie,

W. Scott Beattie

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Keyvan Karkouti,

Keyvan Karkouti

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Duminda N. Wijeysundera,

Duminda N. Wijeysundera

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Terrence M. Yau,

Terrence M. Yau

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Stuart A. McCluskey,

Stuart A. McCluskey

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Adriaan Van Rensburg,

Adriaan Van Rensburg

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W. Scott Beattie,

W. Scott Beattie

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First published: 10 January 2008

https://doi.org/10.1111/j.1537-2995.2007.01590.x

Citations: 78

Keyvan Karkouti, MD, University Health Network, Toronto General Hospital, Department of Anesthesia, EN 3-402, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4; e-mail: [email protected].

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Abstract

BACKGROUND: Current red blood cell (RBC) transfusion guidelines assume that most acutely anemic patients can tolerate hemoglobin (Hb) concentrations as low as 6.0 to 7.0 g per dL and recommend that range as the transfusion threshold in patients who have no overt signs of organ dysfunction. Nonetheless, “normal” Hb concentrations vary widely in the population, and this variability may influence patients' tolerance of acute anemia. This retrospective cohort study was carried out to test this hypothesis.

STUDY DESIGN AND METHODS: Data were analyzed on 10,179 consecutive patients who had normal Hb concentrations (12.0-16.0 g/dL in women and 13.0-18.0 g/dL in men) and underwent on-pump cardiac surgery from 1999 to 2006 at an academic hospital. The relationships of lowest intraoperative Hb concentration and maximum decrease in Hb concentration (from baseline) with the composite outcome of in-hospital death, stroke, or kidney failure were determined in various patient subgroups.

RESULTS: The relationship between lowest Hb concentration and adverse outcomes was not independently associated with increased risk. In contrast, the relationship between maximum decrease in Hb concentration and adverse outcomes was independently associated with increased risk, with a 50 percent decrease being the threshold beyond which risk was increased (adjusted odds ratio, 1.53; 95% confidence interval, 1.12-2.08; p = 0.007).

CONCLUSION: The degree of acute anemia that patients can safely tolerate during cardiac surgery is inversely related to their baseline Hb concentration. Current transfusion guidelines do not account for this relationship.

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Volume48, Issue4

April 2008

Pages 666-672

The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery

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The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery

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