Tissue oxygen delivery and the microcirculation

In health, acute anemia is accompanied by changes in the distribution of blood flows at all of the central, regional, and microcirculatory levels. This redistribution in blood flows provides the capacity to maintain tissue oxygenation with hematocrit as low as 21%. What is not known with certainty is whether the capacity to maintain tissue oxygenation in the presence of acute anemia can be influenced significantly by concurrent disease such as sepsis and cardiac disease. The single clinical trial [2] found an apparent survival benefit by not exposing patients with sepsis to blood transfusions until the hemoglobin concentration was less than 70 g/L. The question remains as to whether this observation was the consequence of a protective effect anemia or an injurious effect of transfusing old stored blood.