Impact of red blood cell transfusion on global and regional measures of oxygenation

Russell S. Roberson, Elliott Bennett-Guerrero

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Anemia is common in critically ill patients. Although the goal of transfusion of red blood cells is to increase oxygen-carrying capacity, there are contradictory results about whether red blood cell transfusion to treat moderate anemia (eg, hemoglobin 7-10 g/dL) improves tissue oxygenation or changes outcomes. Whereas increasing levels of anemia eventually lead to a level of critical oxygen delivery, increased cardiac output and oxygen extraction are homeostatic mechanisms the body uses to prevent a state of dysoxia in the setting of diminished oxygen delivery due to anemia. In order for cardiac output to increase in the face of anemia, normovolemia must be maintained. Transfusion of red blood cells increases blood viscosity, which may actually decrease cardiac output (barring a state of hypovolemia prior to transfusion). Studies have generally shown that transfusion of red blood cells fails to increase oxygen uptake unless oxygen uptake/oxygen delivery dependency exists (eg, severe anemia or strenuous exercise). Recently, near-infrared spectroscopy, which approximates the hemoglobin saturation of venous blood, has been used to investigate whether transfusion of red blood cells increases tissue oxygenation in regional tissue beds (eg, brain, peripheral skeletal muscle). These studies have generally shown increases in near-infrared spectroscopy derived measurements of tissue oxygenation following transfusion. Studies evaluating the effect of transfusion on the microcirculation have shown that transfusion increases the functional capillary density. This article will review fundamental aspects of oxygen delivery and extraction, and the effects of red blood cell transfusion on tissue oxygenation as well as the microcirculation.

Original languageEnglish (US)
Pages (from-to)66-74
Number of pages9
JournalMount Sinai Journal of Medicine
Volume79
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Erythrocyte Transfusion
Oxygen
Anemia
Cardiac Output
Near-Infrared Spectroscopy
Microcirculation
Hemoglobins
Blood Viscosity
Hypovolemia
Conservation of Natural Resources
Critical Illness
Skeletal Muscle
Exercise
Brain

Keywords

  • anemia
  • microcirculation
  • near-infrared spectroscopy
  • oxygen uptake and delivery
  • packed red blood cell transfusion
  • tissue oxygenation
  • video microscopy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Impact of red blood cell transfusion on global and regional measures of oxygenation. / Roberson, Russell S.; Bennett-Guerrero, Elliott.

In: Mount Sinai Journal of Medicine, Vol. 79, No. 1, 01.2012, p. 66-74.

Research output: Contribution to journalArticle

Roberson, Russell S. ; Bennett-Guerrero, Elliott. / Impact of red blood cell transfusion on global and regional measures of oxygenation. In: Mount Sinai Journal of Medicine. 2012 ; Vol. 79, No. 1. pp. 66-74.
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