DOCSLIB.ORG

Hemoglobin Level

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hemoglobin Level Looking at Labs Hemoglobin level Background Clinical alert • Increased Hb levels are found in: Hemoglobin (Hb), the main An Hb value less than 5.0 g/dL ° polycythemia vera component of erythrocytes (red (50 g/L) can lead to heart failure ° heart failure blood cells [RBCs]), serves as the and death. A value greater than ° chronic obstructive pulmonary vehicle for the transportation 20 g/dL (200 g/L) can lead to disease of oxygen and carbon dioxide. obstruction of the capillaries as a • Variation in Hb levels: It is composed of amino acids result of hemoconcentration. ° occurs after transfusions, that form a single protein called hemorrhages, burns. (Hb and globin, and a compound called Clinical implications HCT are both high during heme, which contains iron atoms • Decreased Hb levels are found and immediately after hemor- and the red pigment porphyrin. in anemia states (a condition in rhage.) It is the iron pigment that com- which there is a reduction of Hb, ° The Hb and HCT provide bines readily with oxygen and hematocrit [HCT], or RBC val- valuable information in an gives blood its characteristic red ues). The Hb must be evaluated emergency if they are inter- color. Each gram of Hb can carry along with the RBC count and preted not in an isolated fash- 1.34 mL of oxygen per 100 mL HCT. ion but in conjunction with of blood. The oxygen-combining ° iron deficiency, thalassemia, other pertinent lab data. capacity of the blood is directly pernicious anemia, hemoglo- ° Hb variants can cause varia- proportional to the Hb concentra- binopathies tion in measured Hb: tion rather than to the RBC count ° liver disease, hypothyroidism methemoglobin because some RBCs contain more ° hemorrhage (chronic or acute) sickle cell hemoglobin Hb than others. Therefore, Hb ° hemolytic anemia caused by: fetal hemoglobin determinations are important in transfusions of incompatible deoxyhemoglobin. the evaluation of anemia. blood The Hb determination is part reactions to chemicals or Clinical implications of of a complete blood cell count. drugs polycythemia It is used to screen for disease reactions to infectious agents Polycythemia is the term used to associated with anemia, to deter- reactions to physical agents describe an abnormal increase in mine the severity of anemia, to (severe burns, artificial heat the number of RBCs. Although monitor the response to treat- valves) there are several tests to directly ment for anemia, and to evaluate ° various systemic diseases, determine the RBC mass, these polycythemia. Hb also serves as including: tests are expensive and some- an important buffer in the extra- Hodgkin disease what cumbersome. For screen- cellular fluid. leukemia ing purposes, we rely on the lymphoma HCT and Hb to evaluate polycy- Normal findings systemic lupus erythemato- themia indirectly. Polycythemias • Women: 12.0 to 16.0 g/dL or sus are classified as follows: 120 to 160 g/L carcinomatosis • Relative polycythemia: an • Men: 14.0 to 17.4 g/dL or 140 to sarcoidosis increase in Hb, HCT, or RBC 174 g/L. renal cortical necrosis count caused by a decrease in 34 l Nursing2020CriticalCare l Volume 15, Number 4 www.nursingcriticalcare.com Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. the plasma volume (dehydration, Clinical implications of ° hemorrhagic: acute blood spurious erythrocytosis from anemia loss stress or smoking) Anemias are classified as follows: ° hemolytic: a premature, accel- • Absolute or true polycythemia. • hypoproliferative anemias (inad- erated destruction of RBCs ° primary (polycythemia vera) equate production of RBCs) immune hemolysis ° secondary ° marrow aplasia hemoglobinopathies appropriate (an appropriate ° myelophthisic anemia toxic hemolysis (physical– bone marrow response to ° anemia with blood dyscrasias chemical) physiologic conditions) ° anemia of chronic disease traumatic or microangiopath- – high altitude ° anemia with organ failure ic hemolysis – cardiopulmonary disorder • maturation defect anemias hypersplenism – increased affinity for oxygen ° cytoplasmic: hypochromic enzymopathies inappropriate (an overpro- anemias parasitic infections duction of RBCs not neces- ° nuclear: megaloblastic anemias ° dilutional anemias sary to deliver oxygen to the ° combined: myelodysplastic pregnancy tissues) syndromes splenomegaly. ■ – renal tumor or cyst • hyperproliferative anemias – hepatoma (decreased Hb or HCT despite an – cerebellar hemangioblastoma increased production of RBCs) DOI-10.1097/01.CCN.0000660408.76985.53 www.nursingcriticalcare.com July l Nursing2020CriticalCare l 35 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved..
Load more

Recommended publications
  • Tareq Al-Adaily Ibrahim Elhaj Ayah Fraihat Dana Alnasra Sheet
    Anemia of decreased production II Sheet 3 – + Hemolytic anemia Dana Alnasra Ayah Fraihat Ibrahim Elhaj Tareq Al-adaily 0 **Flashback to previous lectures: − Anemia is the reduction of oxygen carrying capacity of blood secondary to a decrease in red cell mass. − We classified anemia according to cause into: 1. Anemia of blood loss (chronic and acute) 2. Anemia of decreased production 3. Hemolytic anemia − Then, we mentioned general causes for the anemia of decreased production, which are: nutritional deficiency, chronic inflammation, and bone marrow failure. We’ve already discussed the first two and now we will proceed to the last one. Anemias resulting from bone marrow failure: 1. Aplastic anemia 2. Pure red cell aplasia 3. Myelophthisic anemia 4. Myelodysplastic syndrome Other anemias of decreased production: 1. Anemia of renal failure 2. Anemia of liver disease 3. Anemia of hypothyroidism 00:00 1. Aplastic anemia Is a condition where the multipotent myeloid stem cells produced by the bone marrow are damaged. Remember: the bone marrow has stem cells called myeloid stem cells which eventually differentiate into erythrocytes, megakaryocytes (platelets), and myeloblasts (white blood cells). Notice that lymphocytes are not produced from the myeloid progenitor, therefore, they are not affected. depleted normal 1 | P a g e As a result, the bone marrow becomes depleted of hematopoietic cells. And this is reflected as peripheral blood pancytopenia (all blood cells -including reticulocytes- are decreased, with the exception of lymphocytes). Pathogenesis There are two forms of aplastic anemia according to pathogenesis: a. Acquired aplastic anemia It happens because of an extrinsic factor e.g.
    [Show full text]
  • Chapter 03- Diseases of the Blood and Certain Disorders Involving The
    Chapter 3 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50- D89) Excludes2: autoimmune disease (systemic) NOS (M35.9) certain conditions originating in the perinatal period (P00-P96) complications of pregnancy, childbirth and the puerperium (O00-O9A) congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) endocrine, nutritional and metabolic diseases (E00-E88) human immunodeficiency virus [HIV] disease (B20) injury, poisoning and certain other consequences of external causes (S00-T88) neoplasms (C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94) This chapter contains the following blocks: D50-D53 Nutritional anemias D55-D59 Hemolytic anemias D60-D64 Aplastic and other anemias and other bone marrow failure syndromes D65-D69 Coagulation defects, purpura and other hemorrhagic conditions D70-D77 Other disorders of blood and blood-forming organs D78 Intraoperative and postprocedural complications of the spleen D80-D89 Certain disorders involving the immune mechanism Nutritional anemias (D50-D53) D50 Iron deficiency anemia Includes: asiderotic anemia hypochromic anemia D50.0 Iron deficiency anemia secondary to blood loss (chronic) Posthemorrhagic anemia (chronic) Excludes1: acute posthemorrhagic anemia (D62) congenital anemia from fetal blood loss (P61.3) D50.1 Sideropenic dysphagia Kelly-Paterson syndrome Plummer-Vinson syndrome D50.8 Other iron deficiency anemias Iron deficiency anemia due to inadequate dietary
    [Show full text]
  • Table of Contents
    Table of Contents 09.06.02 - RULES GOVERNING MINIMUM MEDICAL\ AND HEALTH STANDARDS FOR PAID FIREMEN 000. LEGAL AUTHORITY. ........................................................................................ 3 001. TITLE AND SCOPE. ......................................................................................... 3 002. WRITTEN INTERPRETATIONS. ...................................................................... 3 003 ADMINISTRATIVE APPEALS. .......................................................................... 3 004.-- 010. (RESERVED). ......................................................................................... 3 Archive011. MINIMUM MEDICAL AND HEALTH STANDARDS FOR PAID FIREMEN. ...... 3 012. ABDOMINAL ORGANS AND GASTROINTESTINAL SYSTEM. ...................... 3 013. BLOOD AND BLOOD-FORMING TISSUE DISEASES. ................................... 4 014. DENTAL. .......................................................................................................... 5 015. EARS. ............................................................................................................... 6 016. HEARING. ......................................................................................................... 6 017. ENDOCRINE AND METABOLIC DISORDERS. ............................................... 7 018. UPPER EXTREMITIES. .................................................................................... 7 019. LOWER EXTREMITIES. ..................................................................................
    [Show full text]
  • Anemia LECTURE in INTERNAL MEDICINE for IV COURSE
    Anemias in the mirror of the real clinical cases LECTURE IN INTERNAL MEDICINE FOR IV COURSE STUDENTS M. Yabluchansky, L. Bogun, L. Martymianova, O. Bychkova, N. Lysenko, M. Brynza V.N. Karazin National University Medical School’ Internal Medicine Dept. Plan of the lecture • Definition • Epidemiology • Etiology & Mechanisms • Adaptation to anaemia • Classification • Clinical investigation • Diagnosis • Treatment • Prognosis • Prophylaxis • Abbreviations • Diagnostic guidelines http://anemiaofchronicdisease.com/wp-content/uploads/2012/08/anemia-of-chronic-disease1.jpg Definition Anemia is a disease and/or a clinical syndrome that consist in lowered ability of the blood to carry oxygen (hypoxia) due to decrease quantity and functional capacity and/or structural disturbances of red blood cells (RBCs) or decrease hemoglobin concentration or hematocrit in the blood A severe form of anemia, in which the hematocrit is below 10%, is called the hyperanemia WHO criteria is Hb < 13 g/dL in men and Hb < 12 g/dL in women (revised criteria for patient’s with malignancy Hb < 14 g/dL in men and Hb < 12g/dL in women) Epidemiology 1 https://www.k4health.org/sites/default/files/anemia-map_updated.png Epidemiology 2 http://img.medscape.com/fullsize/migrated/editorial/conferences/2006/4839/spivak.fig1.jpg Etiology & Mechanisms 1 (basic forms) Basic forms • Blood loss • Deficient erythropoiesis • Excessive hemolysis (RBC destruction) • Fluid overload (hypervolemia) http://www.merckmanuals.com/professional/hematology-and-oncology/approach-to-the-patient-with-anemia/etiology-of-anemia
    [Show full text]
  • Myelophthisic Anemia in a Patient with Lobular Breast Carcinoma Metastasized to the Bone Marrow
    Open Access Case Report DOI: 10.7759/cureus.3541 Myelophthisic Anemia in a Patient with Lobular Breast Carcinoma Metastasized to the Bone Marrow Muhammad H. Khan 1 , Abdurraoof Patel 1 , Purav Patel 1 , Poras Patel 2 , Elizabeth Guevara 2 1. Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA 2. Hematology / Oncology, The Brooklyn Hospital Center, Brooklyn, USA Corresponding author: Muhammad H. Khan, [email protected] Abstract Breast tumors have a predilection for metastasizing to the bone leading to cells being displaced by the cancer cells subsequently producing immature leukocytes and erythrocytes in the peripheral blood. We present a case of a 57-year-old female who was found to have myelophthisic anemia secondary to stage four lobular breast carcinoma metastasized to the bone marrow after being misdiagnosed as having thrombotic thrombocytopenia purpura. Diagnosis of myelophthisic anemia requires a thorough workup and treatment is based upon secondary management of the malignancy. Categories: Internal Medicine, Medical Education, Oncology Keywords: ttp, thrombotic thrombocytopenic purpura, adamst13, a disintegrin and metalloproteinase with a thrombospondin type 1 motif (member 13), er, estrogen receptor, pr, progesterone receptor, her2, human epidermal growth factor receptor 2 Introduction Approximately 252,710 new cases of invasive breast cancer were predicted to occur in the United States in 2017. From 2005 to 2014, the incidence of breast cancer among non-Hispanic blacks increased by 0.4% per year [1]. Breast tumors have a predilection for metastasizing to the bone. When metastasis to the bone marrow occurs, cells are displaced by the space-occupying cancer cells and this leads to immature leukocytes and erythrocytes in the peripheral blood [2-3].
    [Show full text]
  • Hereditary Elliptocytosis CASE REPORT
    JMEDS 10.5005/jp-journals-10045-0012Hereditary Elliptocytosis CASE REPORT Hereditary Elliptocytosis 1PS Sharmila, 2Kannupriya, 3MF Paul ABSTRACT Thailand.4 Inheritance of HE is autosomal dominant. Hereditary elliptocytosis (HE) is a group of disorders However, de novo mutations have been reported in rare characterized by the presence of elliptical-shaped erythrocytes cases. on peripheral blood smear. Hereditary elliptocytosis and its related disorders are characterized by clinical, biochemical, CASE REPORT and genetic heterogeneity. Manifestations range from the asymptomatic carrier state to severe, transfusion dependent A 72 years old male presented to our hospital with history hemolytic anemia. Abnormalities of various membrane protein of abdominal pain and loss of appetite for 1 week. There defects contribute to mechanical defects of the erythrocyte was no significant past or family history. He was a non- membrane skeleton. We present a rare case of HE, an alcoholic, vegetarian. No history of any drug therapy. incidental finding without any clinical symptoms related to it. We also discuss on pathophysiology and being. On clinical examination, patient had tenderness at renal, angle. Ultrasonography (USG) examination of abdomen Keywords: Elliptocytes, Erythrocyte, Hemolysis. and pelvis revealed right-sided mild hydronephrosis How to cite this article: Sharmila PS, Kannupriya, Paul MF. and a small calculus in lower one-third of right ureter. Hereditary Elliptocytosis. J Med Sci 2015;1(2):41-43. Thus with these clinical findings, the diagnosis of right Source of support: Nil hydroureteronephrosis with ureteric calculus was Conflict of interest: None made and patient underwent for lithotripsy for ureteric stone. Laboratory investigations included complete INTRODUCTION hemogram, renal function test and liver function test, Hereditary elliptocytosis (HE) and its variants are preoperatively and postoperatively.
    [Show full text]
  • Hematology Ii
    U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL FORT SAM HOUSTON, TEXAS 78234-6100 HEMATOLOGY II SUBCOURSE MD0857 EDITION 200 DEVELOPMENT This subcourse is approved for resident and correspondence course instruction. It reflects the current thought of the Academy of Health Sciences and conforms to printed Department of the Army doctrine as closely as currently possible. Development and progress render such doctrine continuously subject to change. ADMINISTRATION For comments or questions regarding enrollment, student records, or shipments, contact the Nonresident Instruction Section at DSN 471-5877, commercial (210) 221- 5877, toll-free 1-800-344-2380; fax: 210-221-4012 or DSN 471-4012, e-mail [email protected], or write to: COMMANDER AMEDDC&S ATTN MCCS HSN 2105 11TH STREET SUITE 4192 FORT SAM HOUSTON TX 78234-5064 Approved students whose enrollments remain in good standing may apply to the Nonresident Instruction Section for subsequent courses by telephone, letter, or e-mail. Be sure your social security number is on all correspondence sent to the Academy of Health Sciences. CLARIFICATION OF TRAINING LITERATURE TERMINOLOGY When used in this publication, words such as "he," "him," "his," and "men" are intended to include both the masculine and feminine genders, unless specifically stated otherwise or when obvious in context. USE OF PROPRIETARY NAMES The initial letters of the names of some products are capitalized in this subcourse. Such names are proprietary names, that is, brand names or trademarks. Proprietary names have been used in this subcourse only to make it a more effective learning aid. The use of any name, proprietary or otherwise, should not be interpreted as an endorsement, deprecation, or criticism of a product; nor should such use be considered to interpret the validity of proprietary rights in a name, whether it is registered or not.
    [Show full text]
  • Cdc 12413 DS1.Pdf
    CHAPTER 1 PRINCIPLES OF DIAGNOSIS INTRODUCTION Anemia exists when a person’s level of circulating hemoglobin is lower than that in healthy persons of the same sex and age group in the same environment (Table 1). The most common kinds of anemia are due to nutritional deficiencies of iron, folic acid, and, less commonly, vitamin B12 and protein. Other common causes of anemia are congenital defects of hemoglobin production, namely, sickle cell anemia and other hemoglobinopathies, including thalassemia. Protozoal infections and infes­ tations, particularly malaria and hookworm, are also important direct causes of anemia, and bacterial infections may aggravate an existing anemia and prevent optimal response to hematinics. Because anemia has multiple etiologies, it presents two problems to laboratory personnel: 1. Ascertaining the presence of anemia. 2. Defining the underlying cause of the anemia. The laboratory tests that have been developed for the specialized investi­ gation of anemia during the past two decades can identify many types of Table 1 - Normal lower limits for hemoglobin and PCV* level Hemoglobin (g/L) PCV Infants (full term) 136 .44 Children, 3 months 95 .32 Children, 1 year 110 .36 Children, 10-12 years 120 .38 Women, nonpregnant 120 .38 Women, pregnant 130 .40 Men 130 .40 * Packed Cell Volume These are values at sea level. The hemoglobin (Hb) of most persons increases with altitude; for example, levels for men increase by about 10 g/1 at 2000 m (6500 ft) and by about 20 g/1 at 3000 m (10,000 ft). 2 Anemia anemia; however, most of these types do not represent major public health problems in developing countries, and the extensive laboratory facilities needed to identify them are often not available even in central laboratories in many developing countries.
    [Show full text]
  • Hematologic Changes in Systemic Diseases
    Hematologic changes in systemic diseases Chittima Sirijerachai Systemic diseases • Infection • Renal diseases • Liver diseases • Connective tissue diseases • Malignancy Anemia of chronic disease (ACD) • Chronic infections: • Tuberculosis, HIV infection, osteomyelitis etc. • Chronic inflammatory diseases: • SLE, rheumatoid arthritis, scleroderma, polymyositis • Malignancy • Others Diagnosis • Mild to moderate anemia • Normochromic normocytic anemia( may be hypochromic microcytic anemia) • Low reticulocyte count • Reduced serum iron and TIBC • Normal or increased serum ferritin ACD: treatment • Treat underlying disease • Correct other causes of anemia • PRC transfusion Infection: acute infection • Acute hemolytic anemia (underlying HbH, G-6-PD def) • DIC (severe bacterial infection) • Leukocytosis (bacterial infection) • Leukopenia, transformed lymphocyte (viral infection) • Thrombocytopenia (viral infection) • Immune hemolytic anemia ( Infectious mononucleosis, mycoplasma pneumonia) Thalassemia G-6-PD deficiency with acute hemolysis DIC AIHA Infection: chronic infection • Anemia of chronic disease • Myelophthisis anemia • autoimmune hemolytic anemia Infection: HIV infection • Anemia • Thrombocytopenia • Antiphospholipid syndrome • Lymphoproliferative disorder HIV: anemia • Anemia of chronic disease • Viral infection: CMV, EBV, Parvovirus B19 • Myelophthisic anemia: opportunistic infection, malignancy • Nutritional deficiencies • Autoimmune hemolytic anemia • Bone marrow suppression: drug-induced HIV: anemia - treatment • Correct reversible
    [Show full text]
  • Curriculum Content Report Anemia Prepared 8/15/17 by Ken Olive, MD
    Curriculum Content Report Anemia Prepared 8/15/17 by Ken Olive, MD Year 1 Course Content Case Oriented Learning anemia in end-stage renal disease case Cellular & Molecular Medicine hemoglobin structure and sickle cell disease Genetics Fanconi anemia as a genetic disease Medical Physiology role of GI tract in pernicious anemia, intestinal iron absorption pathways and mechanisms, celiac disease as a clinical condition that can lead to iron deficiency anemia. Year 2 Immunology Blood group antigens, Blood transfusion reactions, Erythroblastosis fetalis/hemolytic disease of the newborn pathophysiology and treatment, Pernicious Anemia pathophysiology and presentation, Intrinsic factor autoantibodies, Cold and warm autoimmune hemolytic anemia, B12 deficiency and anemia subsequent to Crohn’s disease. Medical Microbiology anemia in intestinal parasitic infections, aplastic anemia induced by viruses Clinical Neuroscience pernicious anemia manifesting as neuropathy Pathology pernicious anemia associated with gastritis, anemia in end-stage renal disease, extensive coverage of various anemias in hematology section (including red cell terms and morphology; Classification of anemia: microcytic anemia, macrocytic anemia, hypochromic, normochromic, blood loss; Hemolysis: intravascular hemolysis, extravascular hemolysis, splenomegaly, hepatomegaly; Hereditary RBC defects: hereditary spherocytosis, G6PD deficiency, pyruvate kinase deficiency; Hemoglobinopathies: sickle cell trait, sickle cell disease, hand-foot syndrome, sickling test, hemoglobin C disease,
    [Show full text]
  • Ayah Fraihat HLS- Pathology
    HLS- Pathology Anemia – lecture 3 Ayah Fraihat Anemia of Diminished production Pathogenesis Laboratory findings Notes Aplastic anemia * Extrinsic factor: * decreased - Most cases are idiopathic Activated T- hematopoietic cells in - other associated factors lymphocytes destroy BM (with residual fat) are drugs , some viruses and stem cells due to pregnancy antigen cross reactivity * pancytopenia - immunosuppressive (BM Failure) therapy restores bone * Intrinsic factor: marrow in inherited defects in *normochromic or 70% of cases Telomerase. macrocyctic anemia. - stem cells might (Note: problems with *Special types of AA: express abnormal stem cells give - Fanconi anemia: rare, Antigens attracting T- macrocystic anemias) defect in DNA repair cells proteins>>>mutations. Can lead to leukemia Myelophthisic anemia * Infiltration of bone * pancytopenia *patient comes with skin marrow>>>damaging * Peripheral blood: bleeding hematopoietic cells Immature precursors of (Thrombocytopenia) (Could be Cancer, TB, RBC’s+ granulocytes Storage diseases, * Neutropenia may lead to infections & death Anemia of Renal Deficiency in kidney *increased serum * uremia leads to abnormal disease function>> Low EPO>> creatinine platelets function (due to Decreased RBC * Low EPO change in blood production * low reticulocyte count environment), but doesn’t * Uremia in advanced affect their count. cases (urea nitrogen in blood) *Burr cells (echinocytes) are الخﻻيا secondary to uremia الشوكية Anemia of Liver *multifactorial : *low transferrin *morphology: spur cells Disease
    [Show full text]
  • Anemia in the Emergency Department: Evaluation And
    November 2013 Anemia In The Emergency Volume 15, Number 11 Department: Evaluation And Authors Timothy G. Janz, MD, FACEP, FCCP Professor, Department of Emergency Medicine, Pulmonary/Critical Treatment Care Division, Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH Roy L. Johnson, MD, FAAEM Abstract Assistant Professor, Associate Program Director, Integrated Residency in Emergency Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH Anemia is a common worldwide problem that is associated with Scott D. Rubenstein, MD, MS, EMT-T nonspecific complaints. The initial focus for the emergency evalu- Chief Resident, Wright State University/Wright-Patterson Air Force ation of anemia is to determine whether the problem is acute or Base Combined Emergency Medicine Residency, Dayton, OH chronic. Acute anemia is most commonly associated with blood Peer Reviewers loss, and the patient is usually symptomatic. Chronic anemia is David Cherkas, MD, FACEP usually well tolerated and is often discovered coincidentally. Once Assistant Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY diagnosed, the etiology of anemia can often be determined by Chad Meyers, MD applying a systematic approach to its evaluation. The severity of Director, Emergency Critical Care, Bellevue Hospital Center; the anemia impacts clinical outcomes, particularly in critically ill Assistant Professor of Clinical Emergency Medicine, New York patients; however, the specific threshold to transfuse is uncertain. University School of Medicine, New York, NY Evaluation of the current literature and clinical guidelines does CME Objectives not settle this controversy, but it does help clarify that a restrictive Upon completion of this article, you should be able to: transfusion strategy (ie, for patients with a hemoglobin < 6-8 g/ 1.
    [Show full text]