Eligibility Details:
Inclusion Criteria:
- Males and females older than 18 years of age who have postoperative Hb < 10gm/dl
within 15 days after the index operation
- Patients who undergo an operation in either one of the three following categories:
- Veterans who undergo PAD - related operations including but not limited to the
following:
- aortobifemoral or aortobiiliac bypass
- open abdominal aortic aneurysm repair with simultaneous repair of aortoiliac
occlusive disease
- visceral bypass
- iliofemoral bypass
- femoral bypass or endarterectomy
- infrainguinal bypass
- thromboembolectomy
- supra-aortic trunk bypass or endarterectomy
- carotid endarterectomy
- major lower extremity amputations (transfemoral, through the knee, or
transtibial)
- Veterans with past medical history of ischemic stroke or IHD or PAD who undergo
the following general surgery procedures, defined as:
- known prior MI
- ECG findings consistent with prior MI
- prior percutaneous coronary intervention
- prior coronary artery bypass surgery
- history of angina for which the patient is currently receiving treatment
- stress test indicating myocardial ischemia
- who undergo the following General Surgery operations:
- Open cholecystectomy or other complex biliary reconstruction
- such as open common bile duct exploration for stones
- reconstruction as part of oncologic operations such as palliative
pancreatic cancer procedures)
- small bowel resection
- pancreatectomy
- colon resection
- rectal resection
- splenectomy
- transhiatal esophagectomy
- liver resection
- gastric resection
- open ventral hernia repair
- Colostomies (reversals and takedowns)
- Veterans with past medical history of ischemic stroke or IHD or PAD who undergo
the following Vascular Surgery operations:
- Open aneurysm repair, including but not limited to:
- carotid
- subclavian
- abdominal aortic
- iliac
- femoral
- popliteal aneurysms
- and complex endovascular aneurysm repair, defined as:
- fenestrated endograft
- or endograft with need for iliac conduit
- or endovascular aneurysm repair with simultaneous femoral artery
reconstruction or bypass
- Patients undergoing the above procedures will be included in the study regardless of
their preoperative Hb level, and regardless of preoperative or intraoperative
transfusion they might have received.
Exclusion Criteria:
- Veteran unable to consent
- Veteran unwilling to follow protocol (such as Jehovah's witnesses)
- Veteran with known history of hereditary anemias such as Thalassemia or Sickle cell
disease
- Veteran with known history of hereditary bleeding disorders, such as factor VIII or
factor IX deficiency
- Veteran with prior history of adverse reaction to blood administration, such as fever,
rash, or hemolysis
- Veteran does not speak or understand English
- Veteran hemodynamically unstable or in cardiogenic shock
- Veteran participating in another interventional trial whose objective is to evaluate
the effect of transfusion on outcomes
- Pregnancy in female Veterans
- Veteran is a prisoner or in custody of law enforcement
- Prior randomization in the CSP#599