George et al described postoperative drift in hemoglobin following cardiac surgery. This occurs in the absence of blood loss and so should not be used alone as a trigger for transfusion. The authors are from the Johns Hopkins University.
Patient selection: cardiac surgery
Features of hemoglobin drift:
(1) mild drop in hemoglobin (up to 3 g/dL) after surgery, with nadir 2-4 days after surgery
(2) exclusion of bleeding
(3) hemodynamically stable
(4) gradual increase in hemoglobin over several days not explained by blood transfusion
Factors associated with hemoglobin drift:
(1) increasing time on cardiopulmonary bypass (CPB)
(2) higher body weight
where:
• Hemodilution with delayed diuresis would explain the change in hemoglobin. If so the body weight in the postoperative period should be greater than the preoperative weight only to return to previous levels.
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