Update on Blood Transfusion in Cardiac Surgical Patients

Every day, cardiac surgeons, cardiac anesthesiologists and intensivists ponder the dilemma of whether or not to perform a blood transfusion on their patients. Transfusion practice in the United States varies widely, with several studies showing a 10-92% range for perioperative transfusion in cardiac surgical patients.1-4 These results may reflect a longstanding threshold of 10/30 (hemoglobin of 10g/dl and hematocrit of 30%) to initiate a transfusion in surgical patients.5-8 In fact, cardiac surgery cases account for approximately 10-20% of all blood transfusions, while a small sub-group of high-risk patients (10-20%) consume the other 80% of this scarce resource.9 In general, blood transfusion to treat moderate anemia is not looked upon as a major intervention with significant consequences, especially since immediate adverse side effects may not be apparent.