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16 - Disorders of red cells

Published online by Cambridge University Press:  12 January 2010

By
James R. Eckman
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
James R. Eckman
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
Get access

Summary

Introduction

The primary consideration in medical management of red cell disorders during surgery is to optimize hemoglobin concentration to provide for adequate oxygen delivery to tissues. Blood hemoglobin concentration is a primary direct and indirect determinant of tissue oxygenation. Blood oxygen content increases directly as hemoglobin concentration increases. Tissue oxygen delivery is a complex function of hemoglobin level, cardiac output, hemoglobin oxygen affinity, and tissue oxygen content. As hemoglobin level (more correctly red cell number) increases, blood viscosity increases and cardiac output may decrease so there is an optimal range of hemoglobin concentration that maximizes tissue oxygen delivery. The goal of preoperative and postoperative management is to maintain this optimal level at reasonable cost. Unfortunately, this optimal level is poorly defined in most clinical settings, varies between patients and within individual patients over time, and, even if well defined, can not be maintained without unacceptable complication rates or costs. Perioperative management involves considering the optimal hemoglobin level for each clinical setting based on an informal cost/benefit analysis that usually is supported by incomplete outcome data.

An initial assessment should be done to determine if the hemoglobin level is too high or too low for the specific patient or surgical procedure. Alterations in hemoglobin level may also suggest underlying clinical conditions that may compromise surgical outcome if not properly diagnosed and treated.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 207 - 218
Publisher: Cambridge University Press
Print publication year: 2006

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References

Allen, J. B. & Allen, B. A.The minimum acceptable level of hemoglobin. Int. Anesth. Clin. 1982; 20: 1–22.CrossRefGoogle ScholarPubMed
Carson, J. L., Poses, R. M., Spence, R. K., & Bonavita, G.Severity of anaemia and operative mortality and morbidity. Lancet 1988; 2: 727–729.CrossRefGoogle Scholar
Consensus Conference. Perioperative red blood cell transfusion. J. Am. Med. Assoc. 1988; 260: 2700–2703.CrossRef
Council on Scientific Affairs. Autologous blood transfusions. J. Am. Med. Assoc. 1986; 256: 2378–2380.CrossRef
Etchason, J., Petz, L., Keeler, E.et al. The cost-effectiveness of preoperative autologous blood donations. N. Engl. J. Med. 1995; 332: 719–724.CrossRefGoogle ScholarPubMed
Goodnough, L. T.The role of recombinant growth factors in transfusion medicine. Br. J. Anaesth. 1993; 70: 80–86.CrossRefGoogle ScholarPubMed
Goodnough, L. T., Rudnick, E., Price, T. H.et al. Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy. N. Engl. J. Med. 1989; 321: 1163–1168.CrossRefGoogle ScholarPubMed
Goodnough, L. T., Brecher, M. E., Kanter, M. H., AuBuchon, J. P.Transfusion medicine – blood transfusion. N. Engl. J. Med. 1999; 340: 438–447.CrossRefGoogle ScholarPubMed
Health and Public Policy Committee, American College of Physicians. Practice strategies for elective red blood cell transfusion. Ann. Intern. Med. 1992; 116: 403–406.CrossRef
Herbert, P. C., Wells, G., Blajchman, M. A.et al. A multicenter, randomized controlled clinical trial of transfusion requirements in critical care. N. Engl. J. Med. 1999; 340: 409–417.CrossRefGoogle Scholar
Hillyer, C. D., Silberstein, L. E., Ness, P. M., Anderson, K. C., & Roush, K. S.Blood Banking and Transfusion Medicine: Basic Principles and Practice. Philadelphia, PA: Churchill Livingstone, 2003.Google Scholar
Irving, G. A.Continuing medical education. Perioperative blood and blood component therapy. Can. J. Anaesth. 1992; 39: 1105–1115.CrossRefGoogle Scholar
Leone, B. J. & Spahn, D. R.Anemia, hemodilution, and oxygen delivery. Anesth. Analg. 1992; 75: 651–653.CrossRefGoogle ScholarPubMed
McFarland, J. G.Perioperative blood transfusions: indications and options. Chest 1999; 115: 113S–121S.CrossRefGoogle ScholarPubMed
Toy, P. T. C. Y., Strauss, R. G., Stehling, L. C.et al. Predeposited autologous blood for elective surgery. A National Multicenter Study. N. Engl. J. Med. 1987; 316: 517–520.Google ScholarPubMed
Vengelen-Tyler, V., ed. AABB Technical Manual. 14th edn, Bethesda, MD: American Association of Blood Banks, 2002.Google Scholar
Welch, H. G., Meehan, K. R., & Goodnough, L. T.Prudent strategies for elective red blood cell transfusion. Ann. Intern. Med. 1992; 116: 393–402.CrossRefGoogle ScholarPubMed
Adu-Gyamfi, Y., Sankarakutty, M., & Marwa, S.Use of a tourniquet in patients with sickle-cell disease. Can. J. Anaesth. 1993; 40: 24–27.CrossRefGoogle ScholarPubMed
Bischoff, R. J., Williamson, A. II, Dalali, M. J., Rice, J. C., & Kerstein, M. D.Assessment of the use of transfusion therapy perioperatively in patients with sickle cell hemoglobinopathies. Ann. Surg. 1988; 207: 434–438.CrossRefGoogle ScholarPubMed
Burrington, J. D. & Smith, M. D.Elective and emergency surgery in children with sickle cell disease. Surg. Clin. N. Am. 1976; 56: 55–71.CrossRefGoogle ScholarPubMed
Davis, S. C. & Robets-Harewood, M.Blood transfusion in sickle cell disease. Blood Rev. 1997; 11: 57–71.CrossRefGoogle Scholar
Esseltine, D. W., Baster, M. R. N., & Bevan, J. C.Sickle cell states and the anaesthetist. Can. J. Anaesth. 1988; 35: 385–403.CrossRefGoogle ScholarPubMed
Forrester, K.Anesthetic implications in sickle cell anemia. J. Assoc. Nurs. Anesth. 1986; 54: 314–324.Google ScholarPubMed
Fullerton, M. W., Philippart, A. I., Sarnaik, S., & Lusher, J. M.Preoperative exchange transfusion in sickle cell anemia. J. Pediatr. Surg. 1981; 16: 297–300.CrossRefGoogle ScholarPubMed
Gibson, J. R.Anesthesia for the sickle cell diseases and other hemoglobinopathies. Semin. Anesth. 1987; 6: 27–35.Google Scholar
Janik, J. & Seeler, R. A.Perioperative management of children with sickle hemoglobinopathy. J. Pediatr. Surg. 1980; 15: 117–120.CrossRefGoogle ScholarPubMed
Milner, P. F. & Coker, N. J.Elective surgery in patients with sickle cell anemia. Arch. Otolaryngol. 1982; 108: 547–576.Google Scholar
Morrison, J. C., Whybrew, W. D., & Bucovaz, E. T.Use of partial exchange transfusion preoperatively in patients with sickle cell hemoglobinopathies. Am. J. Obstet. Gynecol. 1978; 132: 59–63.CrossRefGoogle ScholarPubMed
Oduro, K. A. & Searle, J. R.Anaesthesia in sickle-cell states: a plea for simplicity. Br. Med. J. 1972; 4: 596–598.CrossRefGoogle ScholarPubMed
Schlanger, M. & Cunningham, A. J.Intraoperative hypoxemia complicating laparoscopic cholecystectomy in a patient with sickle hemoglobinopathy. Anesth. Analg. 1992; 75: 838–843.Google Scholar
Vichinsky, E. P., Earles, A., Johnson, R. A., Hoag, M. S., Williams, A., & Lubin, B.Alloimmunization in sickle cell anemia and transfusion of racially unmatched blood. N. Engl. J. Med. 1990; 322: 1617–1621.CrossRefGoogle ScholarPubMed
Vishinsky, E. P., Haberkern, C. M., Neumayr, L.et al. A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease. N. Engl. J. Med. 1995; 333: 206–213.CrossRefGoogle Scholar
Vichinsky, E. P.Current issues in blood transfusion in sickle cell disease. Semin. Hematol. 2001; 38: 14–22.CrossRefGoogle ScholarPubMed
Ware, R., Filston, H. C., Schultz, W. H., & Kinney, T. R.Elective cholecystectomy in children with sickle hemoglobinopathies. Ann. Surg. 1988; 208: 17–22.CrossRefGoogle ScholarPubMed
Garratty, G. & Petz, L. D.Approaches to selecting blood for transfusion to patients with autoimmune hemolytic anemia. Transfusion 2002; 42: 1390–1392.CrossRefGoogle ScholarPubMed
Petz, L. D.Transfusing the patient with autoimmune hemolytic anemia. Clin. Lab. Med. 1982; 2: 193–210.Google ScholarPubMed
Plapp, F. V. & Beck, M. L.Transfusion support in the management of immune haemolytic disorders. Clin. Haematol. 1984; 13: 167–183.Google ScholarPubMed
Sokol, R. J., Hewitt, S., Booker, D. J., & Morris, B. M.Patients with red cell antibodies: selection of blood for transfusion. Clin. Lab. Haematol. 1988; 10: 257–264.CrossRefGoogle ScholarPubMed
Berk, P. D., Goldberg, J. D., Donovan, P. B., Fruchtman, S. M., Berlin, N. I., & Wasserman, L. R.Therapeutic recommendations in polycythemia vera based on polycythemia vera study group protocols. Semin. Hematol. 1986; 23: 132–143.Google ScholarPubMed
Fitts, W. T., Erde, A., Peskin, G. W., & Frost, J. W.Surgical implications of polycythemia vera. Ann. Surg. 1960; 152: 548–558.Google ScholarPubMed
Fruchtman, S. M. & Wasserman, L. R. Therapeutic recommendations for polycythemia vera. In Wasserman, L. R., Berk, P. D., Berlin, N. I., eds. Polycythemia Vera and the Myeloproliferative Syndromes. Philadelphia: W. B. Saunders; 1995: 337–350.Google Scholar
Hoffman, R. & Wasserman, L. R.Natural history and management of polycythemia vera. Adv. Intern. Med. 1979; 245: 255–283.Google Scholar
Kaplan, M. E., Mack, K., Goldberg, J. D., Donovan, P. B., Berk, P. D., & Wasserman, L. R.Long-term management of polycythemia vera with hydroxyurea: a progress report. Semin. Hematol. 1986; 23: 167–171.Google ScholarPubMed
Lubarsky, D. A., Gallagher, C. J., & Berend, J. L.Secondary polycythemia does not increase the risk of perioperative hemorrhagic or thrombotic complications. J. Clin. Anesth. 1991; 3: 99–103.CrossRefGoogle ScholarPubMed
Tartaglia, A. P., Goldberg, J. D., Berk, P. D., Wasserman, L. R.Adverse effects of antiaggregating platelet therapy in the treatment of polycythemia vera. Semin. Hematol. 1986; 23: 172–176.Google ScholarPubMed
Wallis, P. J. W., Skehan, J. D., Newland, A. C., Wedzicha, J. A., Mills, P. G., & Empey, D. W.Effects of erythrapheresis on pulmonary haemodynamics and oxygen transport in patients with secondary polycythaemia and cor pulmonale. Clin. Sci. 1986; 70: 91–98.CrossRefGoogle ScholarPubMed
Wasserman, L. R.The treatment of polycythemia vera. Semin. Hematol. 1976; 13: 57–78.Google ScholarPubMed
Wasserman, L. R. & Gilbert, H. S.Surgery in polycythemia vera. N. Engl. J. Med. 1963; 269: 1226–1230.CrossRefGoogle ScholarPubMed
Allen, J. B. & Allen, B. A.The minimum acceptable level of hemoglobin. Int. Anesth. Clin. 1982; 20: 1–22.CrossRefGoogle ScholarPubMed
Carson, J. L., Poses, R. M., Spence, R. K., & Bonavita, G.Severity of anaemia and operative mortality and morbidity. Lancet 1988; 2: 727–729.CrossRefGoogle Scholar
Consensus Conference. Perioperative red blood cell transfusion. J. Am. Med. Assoc. 1988; 260: 2700–2703.CrossRef
Council on Scientific Affairs. Autologous blood transfusions. J. Am. Med. Assoc. 1986; 256: 2378–2380.CrossRef
Etchason, J., Petz, L., Keeler, E.et al. The cost-effectiveness of preoperative autologous blood donations. N. Engl. J. Med. 1995; 332: 719–724.CrossRefGoogle ScholarPubMed
Goodnough, L. T.The role of recombinant growth factors in transfusion medicine. Br. J. Anaesth. 1993; 70: 80–86.CrossRefGoogle ScholarPubMed
Goodnough, L. T., Rudnick, E., Price, T. H.et al. Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy. N. Engl. J. Med. 1989; 321: 1163–1168.CrossRefGoogle ScholarPubMed
Goodnough, L. T., Brecher, M. E., Kanter, M. H., AuBuchon, J. P.Transfusion medicine – blood transfusion. N. Engl. J. Med. 1999; 340: 438–447.CrossRefGoogle ScholarPubMed
Health and Public Policy Committee, American College of Physicians. Practice strategies for elective red blood cell transfusion. Ann. Intern. Med. 1992; 116: 403–406.CrossRef
Herbert, P. C., Wells, G., Blajchman, M. A.et al. A multicenter, randomized controlled clinical trial of transfusion requirements in critical care. N. Engl. J. Med. 1999; 340: 409–417.CrossRefGoogle Scholar
Hillyer, C. D., Silberstein, L. E., Ness, P. M., Anderson, K. C., & Roush, K. S.Blood Banking and Transfusion Medicine: Basic Principles and Practice. Philadelphia, PA: Churchill Livingstone, 2003.Google Scholar
Irving, G. A.Continuing medical education. Perioperative blood and blood component therapy. Can. J. Anaesth. 1992; 39: 1105–1115.CrossRefGoogle Scholar
Leone, B. J. & Spahn, D. R.Anemia, hemodilution, and oxygen delivery. Anesth. Analg. 1992; 75: 651–653.CrossRefGoogle ScholarPubMed
McFarland, J. G.Perioperative blood transfusions: indications and options. Chest 1999; 115: 113S–121S.CrossRefGoogle ScholarPubMed
Toy, P. T. C. Y., Strauss, R. G., Stehling, L. C.et al. Predeposited autologous blood for elective surgery. A National Multicenter Study. N. Engl. J. Med. 1987; 316: 517–520.Google ScholarPubMed
Vengelen-Tyler, V., ed. AABB Technical Manual. 14th edn, Bethesda, MD: American Association of Blood Banks, 2002.Google Scholar
Welch, H. G., Meehan, K. R., & Goodnough, L. T.Prudent strategies for elective red blood cell transfusion. Ann. Intern. Med. 1992; 116: 393–402.CrossRefGoogle ScholarPubMed
Adu-Gyamfi, Y., Sankarakutty, M., & Marwa, S.Use of a tourniquet in patients with sickle-cell disease. Can. J. Anaesth. 1993; 40: 24–27.CrossRefGoogle ScholarPubMed
Bischoff, R. J., Williamson, A. II, Dalali, M. J., Rice, J. C., & Kerstein, M. D.Assessment of the use of transfusion therapy perioperatively in patients with sickle cell hemoglobinopathies. Ann. Surg. 1988; 207: 434–438.CrossRefGoogle ScholarPubMed
Burrington, J. D. & Smith, M. D.Elective and emergency surgery in children with sickle cell disease. Surg. Clin. N. Am. 1976; 56: 55–71.CrossRefGoogle ScholarPubMed
Davis, S. C. & Robets-Harewood, M.Blood transfusion in sickle cell disease. Blood Rev. 1997; 11: 57–71.CrossRefGoogle Scholar
Esseltine, D. W., Baster, M. R. N., & Bevan, J. C.Sickle cell states and the anaesthetist. Can. J. Anaesth. 1988; 35: 385–403.CrossRefGoogle ScholarPubMed
Forrester, K.Anesthetic implications in sickle cell anemia. J. Assoc. Nurs. Anesth. 1986; 54: 314–324.Google ScholarPubMed
Fullerton, M. W., Philippart, A. I., Sarnaik, S., & Lusher, J. M.Preoperative exchange transfusion in sickle cell anemia. J. Pediatr. Surg. 1981; 16: 297–300.CrossRefGoogle ScholarPubMed
Gibson, J. R.Anesthesia for the sickle cell diseases and other hemoglobinopathies. Semin. Anesth. 1987; 6: 27–35.Google Scholar
Janik, J. & Seeler, R. A.Perioperative management of children with sickle hemoglobinopathy. J. Pediatr. Surg. 1980; 15: 117–120.CrossRefGoogle ScholarPubMed
Milner, P. F. & Coker, N. J.Elective surgery in patients with sickle cell anemia. Arch. Otolaryngol. 1982; 108: 547–576.Google Scholar
Morrison, J. C., Whybrew, W. D., & Bucovaz, E. T.Use of partial exchange transfusion preoperatively in patients with sickle cell hemoglobinopathies. Am. J. Obstet. Gynecol. 1978; 132: 59–63.CrossRefGoogle ScholarPubMed
Oduro, K. A. & Searle, J. R.Anaesthesia in sickle-cell states: a plea for simplicity. Br. Med. J. 1972; 4: 596–598.CrossRefGoogle ScholarPubMed
Schlanger, M. & Cunningham, A. J.Intraoperative hypoxemia complicating laparoscopic cholecystectomy in a patient with sickle hemoglobinopathy. Anesth. Analg. 1992; 75: 838–843.Google Scholar
Vichinsky, E. P., Earles, A., Johnson, R. A., Hoag, M. S., Williams, A., & Lubin, B.Alloimmunization in sickle cell anemia and transfusion of racially unmatched blood. N. Engl. J. Med. 1990; 322: 1617–1621.CrossRefGoogle ScholarPubMed
Vishinsky, E. P., Haberkern, C. M., Neumayr, L.et al. A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease. N. Engl. J. Med. 1995; 333: 206–213.CrossRefGoogle Scholar
Vichinsky, E. P.Current issues in blood transfusion in sickle cell disease. Semin. Hematol. 2001; 38: 14–22.CrossRefGoogle ScholarPubMed
Ware, R., Filston, H. C., Schultz, W. H., & Kinney, T. R.Elective cholecystectomy in children with sickle hemoglobinopathies. Ann. Surg. 1988; 208: 17–22.CrossRefGoogle ScholarPubMed
Garratty, G. & Petz, L. D.Approaches to selecting blood for transfusion to patients with autoimmune hemolytic anemia. Transfusion 2002; 42: 1390–1392.CrossRefGoogle ScholarPubMed
Petz, L. D.Transfusing the patient with autoimmune hemolytic anemia. Clin. Lab. Med. 1982; 2: 193–210.Google ScholarPubMed
Plapp, F. V. & Beck, M. L.Transfusion support in the management of immune haemolytic disorders. Clin. Haematol. 1984; 13: 167–183.Google ScholarPubMed
Sokol, R. J., Hewitt, S., Booker, D. J., & Morris, B. M.Patients with red cell antibodies: selection of blood for transfusion. Clin. Lab. Haematol. 1988; 10: 257–264.CrossRefGoogle ScholarPubMed
Berk, P. D., Goldberg, J. D., Donovan, P. B., Fruchtman, S. M., Berlin, N. I., & Wasserman, L. R.Therapeutic recommendations in polycythemia vera based on polycythemia vera study group protocols. Semin. Hematol. 1986; 23: 132–143.Google ScholarPubMed
Fitts, W. T., Erde, A., Peskin, G. W., & Frost, J. W.Surgical implications of polycythemia vera. Ann. Surg. 1960; 152: 548–558.Google ScholarPubMed
Fruchtman, S. M. & Wasserman, L. R. Therapeutic recommendations for polycythemia vera. In Wasserman, L. R., Berk, P. D., Berlin, N. I., eds. Polycythemia Vera and the Myeloproliferative Syndromes. Philadelphia: W. B. Saunders; 1995: 337–350.Google Scholar
Hoffman, R. & Wasserman, L. R.Natural history and management of polycythemia vera. Adv. Intern. Med. 1979; 245: 255–283.Google Scholar
Kaplan, M. E., Mack, K., Goldberg, J. D., Donovan, P. B., Berk, P. D., & Wasserman, L. R.Long-term management of polycythemia vera with hydroxyurea: a progress report. Semin. Hematol. 1986; 23: 167–171.Google ScholarPubMed
Lubarsky, D. A., Gallagher, C. J., & Berend, J. L.Secondary polycythemia does not increase the risk of perioperative hemorrhagic or thrombotic complications. J. Clin. Anesth. 1991; 3: 99–103.CrossRefGoogle ScholarPubMed
Tartaglia, A. P., Goldberg, J. D., Berk, P. D., Wasserman, L. R.Adverse effects of antiaggregating platelet therapy in the treatment of polycythemia vera. Semin. Hematol. 1986; 23: 172–176.Google ScholarPubMed
Wallis, P. J. W., Skehan, J. D., Newland, A. C., Wedzicha, J. A., Mills, P. G., & Empey, D. W.Effects of erythrapheresis on pulmonary haemodynamics and oxygen transport in patients with secondary polycythaemia and cor pulmonale. Clin. Sci. 1986; 70: 91–98.CrossRefGoogle ScholarPubMed
Wasserman, L. R.The treatment of polycythemia vera. Semin. Hematol. 1976; 13: 57–78.Google ScholarPubMed
Wasserman, L. R. & Gilbert, H. S.Surgery in polycythemia vera. N. Engl. J. Med. 1963; 269: 1226–1230.CrossRefGoogle ScholarPubMed

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