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British Journal of Anaesthesia, 2003, Vol. 90, No. 6 719-722
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

II. When should we transfuse critically ill and perioperative patients with known coronary artery disease?{dagger}

T. S. Walsh1 and D. B. L. McClelland2

1 Department of Anaesthetics, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh, EH3 9YW, UK E-mail: tim@walsh.sol.co.uk 2 Scottish National Blood Transfusion Service, Royal Infirmary, Edinburgh, EH3 9YW, UK

{dagger}Declaration of interest. The authors are members of the Audit of Transfusion in Intensive Care in Scotland (ATICS) study group, which has received sponsorship from Ortho Biotech for investigator-led research concerning the epidemiology of blood transfusion during critical illness. This company manufactures erythropoeitin. The company has had no direct influence over the study design, execution or analysis. This sponsorship was managed by the Transfusion Medicine and Research Foundation, through which finances were handled.

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Red blood cell (RBC) transfusion is a life-saving therapy for major haemorrhage. However, many RBC transfusions prescribed for surgical patients or critically ill patients in the intensive care unit (ICU) are to increase haemoglobin concentration when clinically significant bleeding is not present or has stopped.1–3 In these situations the potential benefits of RBC transfusion need to be balanced against the risks associated with it. Transmission of known viral infections by RBC transfusion is extremely rare and the much-debated importance of donor leucocytes is no longer relevant in the UK (and in an increasing number of other countries) because all blood components are leucodepleted before storage. However, other serious complications such as incompatible transfusion resulting from administration errors, and cases of transfusion-associated lung injury (TRALI) continue to occur and to cause significant morbidity and mortality.4

At present, most clinicians prescribing RBC transfusions make a risk/benefit assessment for individual patients based on . . . [Full Text of this Article]

Normal myocardial oxygen kinetics

Myocardial oxygen demand

Animal studies

Clinical studies


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