Blood transfusion for the treatment of acute anaemia in inflammatory bowel disease and other digestive diseases

Table 1 Transfusion haemoglobin threshold according to patient’s age and characteristics and type of anaemia

Haemoglobin threshold (g/dL)	Patients characteristics and type of anaemia
< 5	Patients with chronic anaemia and without risk factors1
< 6	Patients with symptomatic2 chronic anaemia and without risk factors
	Acute anaemia in younger patients
< 7	Asymptomatic chronic anaemia in patients with risk factors
	Acute anaemia in surgical and critically ill patients
< 8	Acute anaemia in surgical patients older than 65 yr
< 9	Acute anaemia in patients with organ dysfunction3
< 10	Patients with massive transfusion
> 10	Do not transfuse

¹Risk factors;

²Symptomatic anaemia;

³Organ dysfunction.

Table 2 Theoretical reasons supporting the restrictive or the liberal use of allogeneic red cells in normovolemic patients

Rationale supporting the liberal use of red cells

Augmenting O2 delivery may improve patient survival and functional recovery

Increased risk of coronary ischaemia due to increased demand

Reduces respiratory work

Age, disease severity and drugs may interfere adaptation to anaemia

Improved safety margin if further blood loss

Increased safety of donor blood products

Rationale supporting the restrictive use of red cells

Moderate anaemia has not proved to increased mortality

Red cell transfusions impair microcirculatory flow

Progressive loss of red cell functionality during storage

Pathologic supply dependency is rare

Risk of pathogen transmission

Immunodepression causing increased infections and tumor relapse following transfusion

Risk of TRALI and TACO

Blood products are increasingly scarce and expensive

TRALI: Transfusion-related acute lung injury; TACO: Transfusion associated circulatory overload.

Table 3 Risks or hazards of allogeneic blood transfusion

Acute transfusion reactions

Immunologic reactions

Acute haemolytic reaction (or THRs)

Febrile non-haemolytic reaction

Allergic reactions: Urticaria and anaphylaxis

Acute non-cardiogenic pulmonary edema: TRALI

Alloimmunization with acute platelet destruction

Non-immunologic reactions

Bacterial contamination

TACO

Hypotensive reaction

Non-immunologic haemolysis

Others: Hypocalcemia, hyperkalemia (cardiac arrest), hypothermia, hyperglycemia, etc

Delayed transfusion reactions

Immunologic reactions

Delayed haemolytic reaction

Alloimmunization against blood cell antigens (also platelets and leukocytes)

Graft vs host disease

Transfusion-related immunomodulation

Post-transfusion purpura

Non-immunologic reaction

Transfusion-transmitted infection: viruses (Hepatitis A, B, C, E, VIH 1-2, West Nile virus, HTLV I-II, Citomegalovirus, Virus Herpes viridae, TTV, SEN-1, SARS, etc), protozoa (malaria, babe biosis, Chagas disease, etc), prion (new variant Creutzfeldt Jacob disease)

Post-transfusion hemosiderosis (iron overload)

TRALI: Transfusion-related acute lung injury; TACO: Transfusion associated circulatory overload.