Is a hemoglobin of 10 g/dL required for surgery? (original) (raw)

1993, Medical Clinics of North America

The "10/30" (hemoglobin/hematocrit) rule has long been recognized and accepted in the medical community as the threshold for transfusion in the perioperative setting. Older textbooks and papers 85 , 106 as well as more recent publications 45 , 49, 53, 79 suggest that preoperative transfusion is indicated if the hemoglobin concentration falls below 10 g/dL. In general, anesthesiologists appear to support the 10 g/dL cutoff. 50, 90, 93 It is unclear how the 10 g/dL threshold was established in practice. Perhaps it was related to the results of an early study that found an increased mortality in patients with hemoglobin levels less than 10 gl dL compared to patients with hemoglobin levels higher than 10 g/dL. 62 An increasing number of publications suggest that there is no absolute threshold for transfusion and that this decision should be based on an assessment of the overall clinical picture presented by the patient. 11,12,30,64,66,99,104 In fact, a National Institutes of Health sponsored consensus conference on perioperative red blood cell transfusions in 1988 concluded that available evidence does not support a single criterion for transfusion,75 More recent publications have come to a similar conclusion, 14, 101 This article reviews the data that support a threshold for transfusion. We begin by describing the risks associated with blood transfusions and how it has changed during the past decade. We then summarize the data in humans and animals that describe the benefits of transfusion and conclude with recommendations on the trigger for red cell transfusion,