A PROSPECTIVE, RANDOMIZED TRIAL LIMITING PERIOPERATIVE RED-BLOOD-CELLTRANSFUSIONS IN VASCULAR PATIENTS

BACKGROUND: Patients undergoing major arterial reconstruction have tra ditionally been transfused with red blood cells to keep hemoglobin con centrations above 10 g/dL in order to prevent anemia-induced myocardia l ischemia. There are no data to support this practice. The hypothesis that vascular patients will tolerate a hemoglobin concentration of 9 g/dL wad examined. METHODS: Ninety-nine patients undergoing elective a ortic and infrainguinal arterial reconstructions were prospectively ra ndomized preoperatively to receive transfusions to maintain a hemoglob in level of either 10 g/dL or 9 g/dL. RESULTS: Despite significantly d ifferent postoperative hemoglobin levels of 11.0 +/- 1.2 versus 9.8 +/ - 1.3 g/dL (P <0.0001), there were no differences in mortality or card iac morbidity rates or length of hospital stay. There were no differen ces in hemodynamic parameters. Oxygen delivery was lower in the group with lower hemoglobin levels, but there was no difference in O-2 consu mption between the groups. CONCLUSIONS: A lower hemoglobin concentrati on was tolerated without adverse clinical outcome. Patients did not co mpensate for anemia by increased myocardial work, but by increasing O- 2 extraction in the peripheral tissues. (C) 1997 by Excerpta Medica, I nc.