Tony Breu
Tony Breu

@tony_breu

7 تغريدة 1 قراءة Dec 16, 2023
1/7
🤔What is the hemodynamic response to a chronic hemoglobin of 1.5 g/dL.
A fascinating 1963 study published in @CircAHA provides some interesting answers. Let's have a look at Patient One.
ahajournals.org
@CircAHA 2/
Patient One had chronic anemia with a hemoglobin 1.5 g/dL. You'll see that before receiving blood they had the following cardiac parameter:
• HR 100 (elevated)
• Cardiac index 8.9 (elevated)
• Stroke index 89 (elevated)
@CircAHA 3/
After transfusion to a hemoglobin of 10 g/dL, the following changes were noted:
• HR 100 (elevated but unchanged)
• Cardiac index 3.4 (decreased and now normal)
• Stroke index 34 (decreased and now normal)
@CircAHA 4/
It is fascinating to observe that the did not change after aggressive transfusion.
The normalization of cardiac output was purely a result of a decease in stroke volume.
@CircAHA 5/
The other interesting observation from Patient One was the change in pulmonary capillary wedge pressure.
• At hemoglobin 1.5 g/dL ☞ 14 mmHg
• At hemoglobin 10 g/dL ☞ 5 mmHg
@CircAHA 6/
Though we don't know if Patient One was in high output heart failure before transfusion, their filling pressures certainly decreased.
@CircAHA 7/7
To read more about why don't we transfuse to a normal hemoglobin, see this recent tweetorial.
x.com

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