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Transfusion in Critical Care

Hébert P, Wells G, Blajchmann M, et al. A multicenter randomized controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999;340:409-17. Landmark study found equal mortality using transfusion thresholds of 7 gm/dl and 10gm/dl and higher mortality with liberal transfusion among younger and less ill patients.

PMID: 9971864

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Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013; 368:11-21. A large multi-center trial that found a hemoglobin goal of 7 mg/dL during acute upper gastrointestinal bleed resulted in a lower risk of re-bleeding, adverse events, and a decreased hazard ratio for death at 6 weeks when compared with a 9 mg/dL target. Patients with rapid exsanguination were excluded. The mortality benefit appears greatest in patients with Child-Pugh class A or B cirrhosis.

PMID: 23281973

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Corwin HL, Gettinger A, Fabian TC, et al. Efficacy and safety of epoetin alfa in critically ill patients. N Engl J Med 2007; 357:965-76. In contrast to the 2002 study by Corwin et al, this study of 1,460 MICU and SICU patients found use of epo did not reduce red cell transfusions, but did increase the risk of thrombotic events. This difference may be related to more stringent transfusion practices in recent years. Trauma patients randomized to epo unexpectedly had lower mortality.

PMID: 12472324

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