In Reply:-The Practice Guidelines for Blood Component Therapy were circulated to the ASA Board of Directors, House of Delegates, and Component Society Presidents, in addition to being presented for comment in an open forum at the annual meeting. The draft document did not contain an abstract. It was added in response to member suggestion. This was done somewhat reluctantly because of concerns that abstracts cannot address all important issues and that readers may not continue beyond the abstract and, therefore, are deprived of additional information related to statements in the abstract. For example, Dr. Miller states that the abstract should indicate that the hemoglobin level is one of several criteria for determining the need for red blood cell (RBC) transfusion. That point is emphasized within the body of the document.
Dr. Miller indicates that the recommendations regarding RBC transfusion could be viewed as contradictory. I disagree. The document does not discourage the use of hemoglobin levels in determining the need for RBC transfusion; it discourages the use of a single hemoglobin “trigger.” Dr. Miller's suggested revision could be interpreted as recommending consideration of the risks of inadequate oxygen-carrying capacity only when the hemoglobin value is between 6 and 10 g/dL. I'm sure he would agree that clinical judgment regarding oxygen-carrying capacity is required at all hemoglobin levels. Is the suggested revision less prone to misinterpretation and confusion than the original?
Linda Stehling, M.D.
Chair, Task Force on Blood Component Therapy
30600 N. Pima Rd.; Scottsdale, Arizona 85262
(Accepted for publication December 18, 1996.)