| Abstract [eng] |
Aim. The aim of this thesis was to identify and analyze publications on the use of red blood cell transfusion in the management of anemia and bleeding, and to assess the role of the Patient Blood Management (PBM) concept in optimizing transfusion requirements. Methods. A literature review was conducted by searching the PubMed/MEDLINE database using the keywords: “erythrocyte transfusion”, “hemorrhage”, “anemia”, “threshold”, “liberal”, “restrictive”, “randomized controlled trial”, “systematic review”, and “meta-analysis”. Used filters: 10 years, English, human. Additionally, information was sought from the World Health Organization (WHO) and other official websites. Results. The synthesized evidence from systematic reviews and meta-analyses indicates that a restrictive red blood cell transfusion strategy is safe in most clinical settings, reduces transfusion requirements, and generally does not adversely affect mortality or major complications. In Holst et al. (2015) analysis, which included 31 randomized trials and 9,813 patients, the restrictive strategy reduced the need for transfusion without affecting mortality or morbidity. Similar findings were reported in the Cochrane reviews by Carson et al., which showed that restrictive thresholds reduce exposure to transfusion while 30-day mortality and major complications remain unchanged. In certain populations, such as those with acute gastrointestinal bleeding, a restrictive strategy was associated with lower mortality and risk of rebleeding, whereas in orthopedics, it reduced both infection rates and the number of transfusions. Furthermore, it has been established that a restrictive strategy is safe for most hemodynamically stable patients and is widely considered a more favorable standard than a liberal strategy. Conclusions. Allogeneic red blood cell transfusion remains essential in hemodynamically unstable patients or in life-threatening bleeding, but in stable patients, priority should be given to a restrictive transfusion strategy and PBM principles. This approach reduces transfusion exposure, limits transfusion-related risks, and supports more rational use of scarce blood resources. |
