Could Less Be Worth More?

The use of biologically active products, such as stored blood, in the therapeutic arsenal generates controversy. With the development of hemotherapy, related complications, such as transfusion-transmitted infections, transfusion-related acute lung injury (TRALI), and severe hemolytic reactions, have become rare.^, However, possible volume overload, with consequent pulmonary edema (transfusion-associated circulatory overload, TACO) and its clinical implications, is associated with a major cause of post-transfusion morbidity and mortality. Predisposing factors for the condition include ischemic cardiomyopathy and chronic kidney disease, often present in the context of acute myocardial infarction (AMI).^,

Anemia can worsen myocardial ischemia in AMI, with an impact on mortality. Two main strategies are present in clinical trials in the management of this condition: restrictive transfusion and liberal transfusion. The choice between these approaches remains a controversial topic, with critical implications for clinical practice and patient outcomes.

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