Anemia versus transfusion: does blood conservation increase the risk of complications?

Orthopedic trauma patients are routinely transfused for anemia even when asymptomatic at rest, despite there being relatively little scientific evidence as to what level of anemia can be safely tolerated. Some surgeons prefer a more liberal approach, transfusing to keep hemoglobin (Hgb) levels at 7.0 g/dL or higher; others prefer a more conservative approach, allowing Hgb levels to drop below 7.0 g/dL. We conducted a study to determine if a more conservative approach might put patients at higher risk of complications of severe anemia. We retrospectively reviewed the cases of 104 patients who were treated by a single surgeon at a level I academic trauma center and who were followed up for at least 1 year. Patients (ages 18-50 years) were divided into 2 groups by lowest Hgb level before first transfusion-under 7.0 g/dL and 7.0 g/dL or higher-and then by whether they had been transfused. Logistic regression analysis was performed. The primary outcome was postoperative complication. There was no increased risk of complication related to anemia (P = .3). However, there was a significant risk of complication related to transfusion (P < .01). Furthermore, there was a dose-dependent effect with each unit transfused (P = .02). In young, healthy, asymptomatic orthopedic trauma patients, a more conservative transfusion strategy (vs a more liberal strategy) did not appear to carry higher risk.