ArticleAnesthesia and analgesia2017
Posttransfusion Increase of Hematocrit per se Does Not Improve Circulatory Oxygen Delivery due to Increased Blood Viscosity.
Article in Anesthesia and analgesia, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 40 citations in OpenAlex.
- Early red blood cell transfusion strategy in septic shock among patients with cancer: the TRANSPORT randomized controlled trial.Intensive care medicine · 2026Trial
- An Established Early Rehabilitation Therapy Demonstrating Higher Efficacy and Safety for Care of Intensive Care Unit Patients.Medical science monitor : international medical journal of experimental and clinical research · 2019Trial
- Acute heat stress induces tissue histopathology, hepatic oxidative stress, and apoptosis in black rockfish (Sebastes schlegelii).Fish physiology and biochemistry · 2026Article
- Physiology, monitoring, and optimisation of perioperative tissue oxygenation: a narrative review.British journal of anaesthesia · 2026Review
- Obesity significantly elevates thromboembolism risk in severe trauma, yet essential resuscitation with TXA and erythrocytes remains safe.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Crossing the line: blood transfusion thresholds in ECMO.Critical care (London, England) · 2025Article
- Association between hemoglobin and in-hospital mortality in critically ill patients with sepsis: evidence from two large databases.BMC infectious diseases · 2024Article
- A mathematical model of tissue axial and radial diffusion in the microvasculature for intravascular microscopy and phosphorescence quenching data.Computers in biology and medicine · 2024Article
- Hemodilution on microvascular oxygen delivery potential of the blood during coronary bypass surgery.Journal of anesthesia · 2022Article
- The Limits of Acute Anemia.Journal of clinical medicine · 2022Review
- A model of anemic tissue perfusion after blood transfusion shows critical role of endothelial response to shear stress stimuli.Journal of applied physiology (Bethesda, Md. : 1985) · 2021Article
- Fetal growth, high altitude, and evolutionary adaptation: a new perspective.American journal of physiology. Regulatory, integrative and comparative physiology · 2021Article
- Intraoperative blood loss may be associated with myocardial injury after non-cardiac surgery.PloS one · 2021Article
- RBC Transfusion Triggers: Is There Anything New?Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2020Review
- Resuscitation From Hemorrhagic Shock With Fresh and Stored Blood and Polymerized Hemoglobin.Shock (Augusta, Ga.) · 2020Article
- Critical Care Society of Southern Africa adult patient blood management guidelines: 2019 Round-table meeting, CCSSA Congress, Durban, 2018.The Southern African journal of critical care : the official journal of the Critical Care Society · 2020Article
- A Mechanistic Analysis of Possible Blood Transfusion Failure to Increase Circulatory Oxygen Delivery in Anemic Patients.Annals of biomedical engineering · 2019Article
- Anemia and acute coronary syndrome: current perspectives.Vascular health and risk management · 2018Review
- Transfusion of Red Blood Cells to Patients with Sepsis.International journal of molecular sciences · 2017Review
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 4 countries.
Funding
Abstract
backgroundBlood transfusion is used to treat acute anemia with the goal of increasing blood oxygen-carrying capacity as determined by hematocrit (Hct) and oxygen delivery (DO2). However, increasing Hct also increases blood viscosity, which may thus lower DO2 if the arterial circulation is a rigid hydraulic system as the resistance to blood flow will increase. The net effect of transfusion on DO2 in this system can be analyzed by using the relationship between Hct and systemic blood viscosity of circulating blood at the posttransfusion Hct to calculate DO2 and comparing this value with pretransfusion DO2. We hypothesized that increasing Hct would increase DO2 and tested our hypothesis by mathematically modeling DO2 in the circulation.
methodsCalculations were made assuming a normal cardiac output (5 L/min) with degrees of anemia ranging from 5% to 80% Hct deficit. We analyzed the effects of transfusing 0.5 or more units of 300 cc of packed red blood cells (PRBCs) at an Hct of 65% and calculated microcirculatory DO2 after accounting for increased blood viscosity and assuming no change in blood pressure. Our model accounts for O2 diffusion out of the circulation before blood arriving to the nutritional circulation and for changes in blood flow velocity. The immediate posttransfusion DO2 was also compared with DO2 after the transient increase in volume due to transfusion has subsided.
resultsBlood transfusion of up to 3 units of PRBCs increased DO2 when Hct (or hemoglobin) was 60% lower than normal, but did not increase DO2 when administered before this threshold.
conclusionsAfter accounting for the effect of increasing blood viscosity on blood flow owing to increasing Hct, we found in a mathematical simulation of DO2 that transfusion of up to 3 units of PRBCs does not increase DO2, unless anemia is the result of an Hct deficit greater than 60%. Observations that transfusions occasionally result in clinical improvement suggest that other mechanisms possibly related to increased blood viscosity may compensate for the absence of increase in DO2.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.