Can lower hemoglobin levels be withstood? Ryohei YAMAMOTO 1 1Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine, Kyoto University pp.110-116
Published Date 2020/1/1
DOI https://doi.org/10.11477/mf.3102200715
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We often perform red blood cell transfusions when the Hb concentration falls below 7-8g /dl, which is based on the results of RCTs of restricted and unrestricted blood transfusions. It is not known how well lower Hb levels can be tolerated. The physiological compensation mechanism works to keep VO2 constant even when the Hb concentration decreases, so Hb levels as low as 5g /dl (Hct 15%) may be tolerated both acutely and chronically. However, this is a hypothesis based on physiological principles and observational study data. In clinical practice, it is appropriate to keep the Hb at 7-8g/dl. This is based on several RCTs. In chronic anemia, transfusion initiation criteria may be considered individually, taking into account the physiological compensation mechanisms at work, the presence or absence of symptoms due to anemia, the chance of iron treatment, and the patient-centered outcomes.

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