Transfusion of packed red blood cells in patients with ischemic heart disease

Objective: To review the current literature concerning the utility of and complications associated with transfusion of packed red blood cells (PRBC) in medical and surgical patients with ischemic heart disease. Data Sources, Study Selection, and Data Extraction: The PubMed database of the National Library of Medicine was searched for all studies investigating the use of PRBC in medical and surgical patients with cardiac disease published since 1999. Relevant background literature from before that date was reviewed for inclusion as well. Data Synthesis: An extensive body of literature has accumulated evaluating the safety and efficacy of transfusion as a therapeutic modality in a wide variety of critically ill patients, including patients with cardiac disease. Most, but not all, of these studies have been retrospective in nature, and methodologies have varied from study to study. Some have involved retrospective reviews of patient records, some have been retrospective analyses of detailed databases prospectively collected for other purposes, and some have been prospective randomized or observational studies. Despite the variability in data sources and study design, with a handful of exceptions, the preponderance of data indicates that transfusion of PRBC in the population of patients with ischemic heart disease is of limited clinical utility and may carry the potential for serious adverse consequences. Conclusions: Based on the current literature, there appears to be no indication for routine transfusion in patients with non-ST-elevation acute coronary syndrome, although anemic patients with ST-elevation myocardial infarction may benefit from this intervention. However, the specific indications for transfusion in this population remain ill-defined.