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Critical Care Medicine


Answer 4
  1. 21% to 27%. Chronically ill septic patients may have hemoglobin levels in the range of 8 to 10 g/dL or may quickly achieve these levels due to the dilutional effects of fluid resuscitation. Some dilution may improve circulation and oxygen delivery.1 Although it is likely that an elderly septic patient may have some degree of peripheral or cardiovascular disease, most critically ill patients with cardiovascular disease in the absence of an acute myocardial infarction or unstable angina can tolerate hemoglobin levels of 7 to 9 g/dL (hematocrit of approximately 21%-27%).5 The transfusion of aged blood cells may not improve oxygen transport and may in fact have deleterious immunologic implications.

    REFERENCES
    1. Hollenberg SM, Ahrens TS, Annane D, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004;32:1928-48.

    5. Hebert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group. Crit Care Med 2001;29:227-34.

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