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Communications to the Editor |

Blood Transfusion—Always a Minimum of Two Units? FREE TO VIEW

John P. Judson, MD, FCCP
Author and Funding Information

Lemoyne, PA

Correspondence to: John P. Judson, MD, FCCP, 512 Bridgeview Drive, Lemoyne, PA 17043; e-mail: Drjudson@aol.com



Chest. 2000;118(2):567-568. doi:10.1378/chest.118.2.567-a
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To the Editor:

The issue of blood transfusion was raised in an excellent article by Erik Fransen et al1and by the editorial comment of Harold L. Corwin.2 One more point needs to be added to the discussion. It is generally agreed that routine blood transfusion is of no merit. Most physicians and surgeons also agree that hematocrit or hemoglobin values alone are not often indications to accept the hazards of blood transfusion. Physiologic impairment related to inadequate oxygen transport, secondary to decreased circulating red blood cells, seems to be the current major indicator for transfusion. Unfortunately, there is still a philosophy that, when transfusion is indicated, a minimum of two units of packed red cells should be given to an average size adult. If we really believe that the hazards and risks of transfusion are directly related to the number of units administered, it would seem reasonable to discard the two-unit minimum. When a patient reaches a point where augmentation of the red cell mass is indicated and active bleeding is not present, a single unit will often turn the tide. If the observed improvement is inadequate, a second or third unit can be given. The point is, however, if we are to“ do no harm,” we should administer only the amount of blood actually needed by the patient. Giving two units of red cells automatically, in every case of adult transfusion, as was the teaching when transfusion indications were less stringent and we knew less about associated hazards, is no longer reasonable and should be avoided.

References

Fransen, E, Maessen, J, Dentener, M, et al (1999) Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery.Chest116,1233-1246
 
Corwin, HL Blood transfusion; first do no harm.Chest1999;116,149-1150
 

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References

Fransen, E, Maessen, J, Dentener, M, et al (1999) Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery.Chest116,1233-1246
 
Corwin, HL Blood transfusion; first do no harm.Chest1999;116,149-1150
 
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