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Anemia and Patient Blood Management in Cardiac Surgery-Literature Review and Current Evidence.

The prevalence of anemia is high in patients undergoing cardiac surgery. There is enough evidence that the presence of anemia increases perioperative mortality and morbidity both in noncardiac and cardiac surgery. Anemia is an independent risk factor for increased blood transfusion, length of stay, morbidity, and poor outcomes. It is prudent to delay elective surgery to enhance erythropoiesis preoperatively. There is a synergistic interaction between anemia and blood transfusion in cardiac surgery resulting in worse outcomes that are greater than simply the additive effects of both conditions. Although blood transfusions save lives, the indiscriminate use of transfusions is without any strong supporting evidence. The current literature is not clear on the benefits of a restrictive transfusion strategy during adult cardiac surgery. Observational studies and/or trials in noncardiac surgery should not be used as guidelines to make transfusion decisions for patients undergoing cardiac surgery. Guidelines for cardiac surgery patients should be developed only from the trials performed within this population. One’s decision to transfuse should not be based solely on a single hemoglobin level. Because of the risks