Hemoglobin Threshold for Transfusion in Septic Shock

Hemoglobin Threshold for Transfusion in Septic ShockTo the Editor: Holst et al. (Oct.9 issue) 1 found no significant differences in 90-day mortality and the rate of overt ischemic events between a lower and a higher hemoglobin threshold for transfusion in patients with septic shock.This study did not assess the occurrence of silent ischemic events that may have a substantial effect on long-term outcomes.Previous studies have shown that a low hemoglobin concentration is associated with silent cerebral ischemia in specific populations (e.g., patients with sickle cell anemia, those who require dialysis, and those with -thalassemia). 2In children with sickle cell anemia, silent cerebral infarction is associated with cognitive impairment and an increased risk of stroke.A recent controlled trial by DeBaun et al. showed that regular blood-transfusion therapy significantly reduced the incidence of recurrence of both silent and overt cerebral infarction in this group. 3 To rule out whether patients with septic shock who have a lower hemoglobin concentration are at risk for ischemic events such as silent cerebral ischemia and cognitive impairment, both brain imaging and cognitive-function tests after hospital discharge should be considered.