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European Heart Journal 1997 18(12):1973-1976;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

The haematological management of patients with cyanotic congenital heart disease

A time for consensus?

L. Swan, D. H. Birnie* and W. S. Hillis

Department of Medicine & Therapeutics, University of Glasgow Glasgow, U.K.
*Department of Medicine, Dumfries Royal Infirmary Dumfries, U.K.

Received 20 June 1997; accepted 26 June 1997.

Correspondence: Dr L. Swan, Clinical Research Fellow, Department of Medicine & Therapeutics, University of Glasgow, Western Infirmary, Church Street, Glasgow G11 6NT, U.K.

Abstract

AIMS: Recurrent venesection of patients with cyanotic congenital heart disease may be detrimental, with an increased risk of cerebrovascular events and symptomatic iron-deficiency. The aim of this study was to determine the venesection policies as practised in hospitals within a U.K. region and to determine if these policies followed current recommendations.

METHODS AND RESULTS: Fifty-eight consultants (56% response rate) in cardiac specialties completed self-assessment questionnaires regarding the indications for and practice of venesection. Sixty-one percent of those responding were involved directly in the care of patients with cyanotic congenital heart disease and of these clinicians 97% used venesection. Indications for venesection varied, with 51% of those responding using an elevated haemoglobin per se (6·5–21·0 g.dl–1); 78% an elevated haematocrit (0·55–0·75) and 83% symptoms. Desired maintenance haemoglobin and haematocrit levels also varied greatly. Fifty percent of the consultants responding routinely screened their patients for iron deficiency and 23% felt there was no indication for investigating a low mean corpuscular volume. Only 18% of the policies described followed any evidence based principles.

CONCLUSIONS: The practice of venesecting patients with congenital cyanotic heart disease varies greatly. Policies in many hospitals do not reflect the minimal benefits and considerable risks associated with recurrent venesection.

Key Words: Cyanotic congenital heart disease • adult venesection erythrocytosis


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