What do you think are the symptoms that require blood transfusion during cardiopulmonary bypass?
I think transfusion decision make on hemoglobin level not on the basis of symptoms. Before surgery i think hemoglobin level must be greater then 10 g/dl. Post surgery Hemoglobin must maintain it should be more then 8 g/dl. Less then 8g/dl is indication for transfusion cardiopulmonary bypass.
The programs that are most progressive don't transfuse due to any single number. They look for signs of inadequate oxygen delivery based upon current metabolic needs. So, Venous Saturation, VeCO2 (an indication of metabolic rate, and if anaerobic metabolism is starting to occur it will rise in relation to VO2), lactate increasing (or already above 2 mmol/L), DO2index, DO2i/VeCO2 ratio, and other parameters/comparisons/ratios. At high Cardiac Outputs with low metabolic requirements, I've seen patients doing well with a Hemoglobin below 6 gm/dL. I've also seen those that struggle even with Hemoglobin at 10. Back in the 1970's, we used to give blood and see the venous saturation pop upwards, which we thought justified that transfusion. We didn't understand that 2, 3 DPG stores were depleted in that transfused blood, so the oxy-hemoglobin curve was severely shifted to the left. Although that transfused blood was picking up oxygen, it was not releasing it normally at the tissue level. The Venous Saturation increased NOT due to increased satisfaction of meeting O2 demand, but, due to O2 not readily leaving the Hb molecule. It's more involved than one single number...
extracorporeal circulation accompanied by cardiac index 2.0-2.4. I would follow these parameters for transfusion with most progressive programs
ecO2ER ( oxygen extraction) 5
VCO2i 200 mL/min/m2
I think it might need transfusion when these values deteriorate
- Badges
- Science topic
- Similar topics
- Cognitive Science
- Thinking