RT Book, Section A1 Avery IV, Edwin G. A1 Klick, John C. A2 Longnecker, David E. A2 Mackey, Sean C. A2 Newman, Mark F. A2 Sandberg, Warren S. A2 Zapol, Warren M. SR Print(0) ID 1144113445 T1 The Patient With Anemia and Coagulation Disorders T2 Anesthesiology, 3e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9780071848817 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144113445 RD 2024/03/28 AB KEY POINTSAnemia is common among perioperative patients.Hemoglobin (Hb) concentration or hematocrit (HCT) level is used to rapidly assess the severity of anemia in most clinical situations.Treatment of anemia is based on the physiology and etiology of anemia. Restoration of normovolemia and cardiac output are necessary but insufficient aims in treating anemia.Tachycardia and hypotension can be important clinical signs of hypovolemia and anemia, but compensatory increases in heart and cardiac output may be impeded by insufficient cardiac reserve or anesthetic-related sympathectomy.Consideration of the magnitude of hemorrhage along with the physiologic signs and laboratory evidence for inadequate tissue oxygen delivery is mandatory before making the decision to transfuse red blood cells. The storage duration of red blood cells is not a clinical issue that should affect the decision to transfuse.Evidence-based outcomes supporting a transfusion trigger level of Hb or HCT in all perioperative clinical settings do not exist; however, available information suggests that for most patients Hb levels as low as 7 to 8 g/dL may be as safe as higher levels in critically ill patients.Goals of the perioperative management of patients with sickle cell disease focus on clinical measures to avoid precipitating a vaso-occlusive crisis and include avoiding hypoxia, hypothermia, and dehydration. In addition, use of standard or exchange red blood cell transfusions to reduce the HbS concentration to less than 30% to 40% can be helpful to reduce the incidence of a perioperative vaso-occlusive crisis.