tag:blogger.com,1999:blog-2760353953251845523.post2881097409758368632..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: Over TransfusedJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-2760353953251845523.post-65007619686597234812013-01-09T06:30:13.472-05:002013-01-09T06:30:13.472-05:00I wholly agree with you, although I admit I did no...I wholly agree with you, although I admit I did not take the time to read the entire article.<br /><br />Symptomatic anaemia is (or should be) another extremely important factor in deciding to transfuse. A patient who gets dizziness, SoB and chest pains at Hb 8 is going to get two units from me, even if they don't have any KNOWN heart history. Therefore, indeed, an Hb threshold established more or less arbitrary, might not mean much.<br /><br />For the specific problem of upper GI bleed (but not only), the rate of the blood loss is, I think, just as important as any instantaneous Hb value. If I get a 9 on admission I won't be going to sleep reassured. If I get another 9 in two hours, yes, maybe.<br /><br />This issue should probably looked at the same way as trauma, I agree.<br /><br />This sort of study reminds me of the one comparing outcomes in appendicitis with or without surgery, with all its inherent patient selection problems, etc.. It proved, of course, that surgery is superior. This type of enterprise illustrates, in my opinion, a good way to abuse evidence-based medicine. Statistics do not absolve the scientist from starting with a decent hypothesis AND a plausible mechanism behind what is being researched.Paracelsushttp://netarhia.com/paracelsusnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-10103236669593620982013-01-09T06:17:02.373-05:002013-01-09T06:17:02.373-05:00If you are going to draw from Trauma what about pe...If you are going to draw from Trauma what about permissive hypertension?Anonymousnoreply@blogger.com