We read with great interest the recent review discussing the clinical interpretation of lactate measurements by Drs. Pino and Singh. The article covered the topic in great detail; however, there are several points which we also feel warrant inclusion when discussing this topic.

An additional source of lactate in surgical patients can be from red blood cell transfusion. As the authors state, red cells are completely anaerobic because they lack mitochondria and require glycolysis for maintenance of adenosine triphosphate. As a result, stored red blood cells are a source of lactate from transfusions; lactate levels and resultant patient lactate loads can increase with the use of stored red blood cells. Although many patients have adequate capability to metabolize lactate loads from transfusion, this may not be the case in massive transfusions, liver transplantation, or pediatric cardiac surgery....

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