{"id":2697,"date":"2026-09-30T11:11:25","date_gmt":"2026-09-30T06:11:25","guid":{"rendered":"https:\/\/journal.nncf.kz\/?p=2697"},"modified":"2026-10-10T12:01:32","modified_gmt":"2026-10-10T07:01:32","slug":"%d0%ba%d0%bb%d0%b8%d0%bd%d0%b8%d1%87%d0%b5%d1%81%d0%ba%d0%be%d0%b5-%d0%b7%d0%bd%d0%b0%d1%87%d0%b5%d0%bd%d0%b8%d0%b5-%d0%bc%d0%be%d0%bd%d0%b8%d1%82%d0%be%d1%80%d0%b8%d0%bd%d0%b3%d0%b0-%d0%b0%d1%80","status":"publish","type":"post","link":"https:\/\/journal.nncf.kz\/en\/%d0%ba%d0%bb%d0%b8%d0%bd%d0%b8%d1%87%d0%b5%d1%81%d0%ba%d0%be%d0%b5-%d0%b7%d0%bd%d0%b0%d1%87%d0%b5%d0%bd%d0%b8%d0%b5-%d0%bc%d0%be%d0%bd%d0%b8%d1%82%d0%be%d1%80%d0%b8%d0%bd%d0%b3%d0%b0-%d0%b0%d1%80\/","title":{"rendered":"THE CLINICAL SIGNIFICANCE OF MONITORING THE ARTERIOVENOUS OXYGEN DIFFERENCE IN ASSESSING THE EFFECTIVENESS OF HEMOTRANSFUSION IN TUBERCULOSIS PATIENTS WITH SEVERE ANEMIA"},"content":{"rendered":"

Received: June 10, 2026<\/em>
\nAccepted for publication: July 24, 2026<\/em>
\nPublished online: September 30, 2026<\/em>
\nUDC: 616-08-031.81<\/em>
\nDOI: 10.26212\/2227-1937.2026.38.60.001<\/a><\/em><\/p>\n

\u00a0<\/em><\/p>\n

THE CLINICAL SIGNIFICANCE OF MONITORING THE ARTERIOVENOUS OXYGEN DIFFERENCE IN ASSESSING THE EFFECTIVENESS OF HEMOTRANSFUSION IN TUBERCULOSIS PATIENTS WITH SEVERE ANEMIA<\/p>\n

\u00a0<\/strong><\/p>\n

Muzdubayeva B.T.1<\/sup><\/strong><\/p>\n

National Scientific Center of Phthisiopulmonology of the Republic of Kazakhstan, Almaty, Kazakhstan<\/em><\/p>\n

\u00a0<\/em><\/p>\n

Introduction:<\/strong> Severe forms of tuberculosis almost always occur against the background of anemic syndrome. Anemia in such patients combines signs of chronic inflammation, an iron deficiency component, intoxication and drug suppression of the bone marrow. When the hemoglobin (Hb) level drops below 70 g\/l, oxygen transport is disrupted, which requires red blood cell transfusion. The traditional approach to transfusion therapy, focused only on hemoglobin levels, does not always reflect the actual oxygen status of tissues, which can lead to unjustified or insufficient transfusions. For patients with tuberculosis, this is associated with the risks of transfusion-related immunosuppression, which can provoke the progression of a specific process. Under these conditions, the arterio-venous oxygen difference (AvDO2) becomes the most objective physiological parameter. The AvDO2 indicator indicates the sufficiency of blood hemoglobin in order to provide the body with oxygen. The study of AvDO2 makes it possible to move from formal replacement of red blood cell deficiency to clinically based transfusion therapy. This makes it possible to determine the moment when tissue hypoxia is stopped, and further transfusion does not bring clinical benefit, thereby increasing the safety of treatment for the most severe category of patients.<\/p>\n

Objective. <\/strong>To study the dynamics of the arterio-venous oxygen difference as a marker of oxygen transport adequacy for assessing the clinical efficacy of erythrocyte suspension transfusion in patients with pulmonary tuberculosis and severe anemia.<\/p>\n

Materials and Methods<\/strong>. The study included 33 patients with fibrous-cavernous and disseminated pulmonary tuberculosis with a hemoglobin level of less than 70 g. Arterial blood was taken synchronously from the radial artery and venous blood from the central venous catheter from the jugular vein one hour after the red blood cell transfusion.<\/p>\n

The main group included 18 patients, the decision on transfusion of which was made not only by the level of hemoglobin, but also by the arterio-venous difference in oxygen. Inclusion criterion: hemoglobin < 70 g\/l+ signs of tissue hypoxia: increased AvDO2 > 50 ml\/l with oxygen extraction coefficient – O2ER > 60%, oxygen saturation of venous blood – SvO2 < 60%. Transfusion was performed until AvDO2 and O2ER were normalized with an increase in SvO2. The control group included 15 patients whose transfusion efficacy was assessed by a hemoglobin threshold of more than 70 g\/l. For statistical data processing, the STATISTICA program was used, M \u00b1 m (average \u00b1 error of average).\u00a0 The differences were considered significant at p < 0.05.<\/p>\n

Results<\/strong> Before transfusion, patients in the main group had an AvDO2 of over 55-65 ml\/l and a low saturation of mixed venous blood SvO2 < 60%. This meant that the tissues were operating in the “maximum extraction” mode due to hemoglobin deficiency. Red blood cell transfusion was performed until AvDO2 decreased to 45-50 ml\/l ml\/L. This required 2 doses of red blood cells in 13 (76%) patients and 3 doses of red blood cells in 5 (24%) patients of the main group.<\/p>\n

In the control group, the target hemoglobin level was achieved with large volumes of transfused red blood cells \u2013 2 doses in 3 (20%) patients and 3 doses of red blood cells in 12 (80%) patients. Thus, the number of transfused doses when the target hemoglobin level was reached in the control group was 56% higher.<\/p>\n

Discussion<\/strong>. Comparative analysis showed the advantage of AvDO2 monitoring over standard hemoglobin level control: in the main group, a decrease in the arteriovenous difference to a physiological level (45-50 ml\/l) served as an objective indicator that tissue hypoxia had been relieved. This allowed the transfusion to be completed when the optimal level of venous blood saturation was reached, without seeking to formally achieve a high hemoglobin level. In the control group, 56% more transfusions were required to achieve optimal hemoglobin levels. The volume of transfusion was determined depending on the initial hemoglobin level, taking into account the fact that one dose of red blood cells conditionally increases blood hemoglobin by 10 g\/l.<\/p>\n

Conclusions. <\/strong>The arterio-venous oxygen difference is a more sensitive and reliable marker of the effectiveness of hemotransfusion in tuberculosis patients than the hemoglobin concentration. Transfusion was considered effective in which AvDO2 normalized to an average of 42.1 \u00b1 2.4 ml\/l and O2ER decreased by less than 60% and SvO2 increased by more than 60%, which objectively confirmed the elimination of oxygen “debt” and contributed to a 56% decrease in transfusion volume in the main group.<\/p>\n

Keywords: <\/strong>tuberculosis, severe anemia, erythrocyte transfusion, arterio-venous difference, tissue hypoxia.<\/p>\n\n