kan transfüzyon eşikleri

 For most hemodynamically stable medical and surgical patients, 

we recommend using a restrictive transfusion strategy (giving less blood; transfusing at a lower hemoglobin level [typically 7 to 8 g/dL]

Major exceptions to the use of a threshold of 7 to 8 g/dL, where evidence is insufficient to guide therapy, include the following:

●Symptomatic patients may be transfused at higher hemoglobin levels to treat symptoms. 

●Patients with acute coronary syndromes (ACS) may require higher thresholds for transfusion. 

●Threshold-based transfusion is not appropriate for patients requiring massive transfusion, such as in the setting of trauma or serious gastrointestinal bleeding. Rather, estimated blood loss and hemodynamic status should guide transfusion given the delay for hemoglobin to equilibrate and time waiting for hemoglobin levels to be reported. 

●Chronic transfusion-dependent anemia, such as sickle cell disease or thalassemia. 

●Certain cases of severe thrombocytopenia.

Symptomatic patient — We agree with the premise that symptomatic anemia should be treated with transfusion in patients with hemoglobin <10 g/dL

Acute and chronic cardiovascular disease —

ACS (including MI) — ACS includes unstable angina and acute myocardial infarction (MI). Our practice in patients with ACS is to transfuse when the hemoglobin is <8 g/dL and to consider transfusion when the hemoglobin is 8 to 10 g/dL. We maintain the hemoglobin ≥10 g/dL if the patient has ongoing ischemia, hemodynamic instability, or other symptoms.

- yani AKS  hastalarında hgb i  10 a doğru çıkarmak lazım  

Preexisting coronary artery disease — we consider the threshold of 8 g/dL safe for asymptomatic medical patients with stable coronary artery disease

Kalp yetmezliği - In patients with HF who do not have symptoms attributable to anemia, we suggest using a restrictive red blood cell transfusion strategy (reserving transfusion for a lower hemoglobin level rather than transfusing at a higher hemoglobin level). In general, transfusion should be considered when the hemoglobin is ≤7 to 8 g/dL

Septic shock — A hemoglobin threshold of 7 g/dL was shown to be safe in patients with septic shock

Acute bleeding — For patients with massive bleeding or who are hemodynamically unstable, transfusion should be guided by hemodynamic parameters (pulse, blood pressure), the pace of the bleeding, and the ability to stop the bleeding, rather than by the hemoglobin.

KBY - 

Diyaliz - most patients on dialysis should have an Hb level of at least 10 g/dL

Oncology patient — 

patients undergoing cancer therapy with curative intent should be transfused similarly to other medical patients, with transfusion for symptoms and consideration of transfusion at a threshold hemoglobin of 7 to 8 g/dL in the absence of symptoms.

The AABB clinical practice guideline notes that the restrictive transfusion threshold does not apply to patients with severe thrombocytopenia who are at risk of bleeding