Is that Hemoglobin High Enough? COPYRIGHT © 2014, ALL RIGHTS RESERVED From the Publishers of.

Is that Hemoglobin High Enough?

COPYRIGHT © 2014, ALL RIGHTS RESERVED

From the Publishers of

Copyright © 2014

Terms of Use

The Consult Guys® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of ACP.

The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice.

Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the Consult Guys® slide sets constitutes copyright infringement.

Copyright © 2014

Dear Consult Guys:

I need your advice regarding the practice style of one of our newest

physician hires. He joined us in 2012 after completion of his residency

and now does most of the care of our hospital patients. While he seems

to be excellent I have a major gripe with his management of our

seriously ill patients in the ICU.

My complaint relates to his management of our ICU patients and

postoperative patients who are anemic. Based on my training (I

began practice 25 years ago) I’ve been liberal regarding the approach

to anemia in our ICU and postoperative patients. I think that a Hgb as

close to 10 gm/dl really helps to maximize oxygen delivery.

Our newest associate’s approach to blood transfusion is much more

restrictive. He seems to tolerate a Hgb as low at 7 g/dL in the ICU

patient and 8 g/dL in the post operative patient. I think that his

approach is wrong and may even be dangerous.

By the end of this year we’ll have to decide whether or not to give him a

long term contract. What do you guys think?

A.B.

Corncob General Medical Assoc

Dear Consult Guys:

I need your advice regarding the practice style of one of our newest

physician hires. He joined us in 2012 after completion of his residency

and now does most of the care of our hospital patients. While he seems

to be excellent I have a major gripe with his management of our

seriously ill patients in the ICU.

My complaint relates to his management of our ICU patients and

postoperative patients who are anemic. Based on my training (I

began practice 25 years ago) I’ve been liberal regarding the approach

to anemia in our ICU and postoperative patients. I think that a Hgb as

close to 10 gm/dl really helps to maximize oxygen delivery.

Our newest associate’s approach to blood transfusion is much more

restrictive. He seems to tolerate a Hgb as low at 7 g/dL in the ICU

patient and 8 g/dL in the post operative patient. I think that his

approach is wrong and may even be dangerous.

By the end of this year we’ll have to decide whether or not to give him a

long term contract. What do you guys think?

A.B.

Corncob General Medical Assoc

A Difference of Opinion

How high should Hgb be in the ICU and postoperative patient?

LIBERAL (higher Hgb goals) Hgb 10-12

RESTRICTIVE (transfusion approach) Hgb 7-9

Doesn’t the LIBERAL approach deliver more O2 to the tissues and improve outcome?

Copyright © 2014

Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365:2453-62.

Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N

Engl J Med 1999;340:409-417.

Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB*

Restrictive transfusion in hospitalized stable patientTransfuse if Hgb < 7-8 Restrictive transfusion in hospitalized patient with CV

diseaseTransfuse if symptomatic or Hgb < 8Transfusion decisions guided by symptoms and HgbNo data for guide in hospitalized stable ACS patient

Copyright © 2014

Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery

Patients > age 50 Known or at risk for cardiovascular disease Hip fracture surgery

Liberal: transfuse if Hgb< 10Restrictive: transfuse if anemia symptoms or Hgb<8No difference in:

Mortality Morbidity Functional capacity at 60 days postop

Copyright © 2014

Is that Hemoglobin High Enough? COPYRIGHT © 2014, ALL RIGHTS RESERVED From the Publishers of.

Documents

Transcript of Is that Hemoglobin High Enough? COPYRIGHT © 2014, ALL RIGHTS RESERVED From the Publishers of.