Red Blood Cell Transfusions: Less Is More!

Guideline Watch |
May 14, 2012

Red Blood Cell Transfusions: Less Is More!

  1. Aaron J. Calderon, MD, FACP

A new guideline recommends a restrictive transfusion strategy for most hospitalized patients.

  1. Aaron J. Calderon, MD, FACP

Roughly 15 million red blood cell (RBC) units are transfused annually in the U.S., but transfusion practices vary substantially, partly because of limited high-quality evidence regarding risks and benefits of RBC transfusions. To develop a clinical practice guideline on transfusion practices for hemodynamically stable adults and children, the AABB performed a systematic review of randomized clinical trials in which RBC transfusion thresholds were evaluated.

Key recommendations include the following:

  • In stable hospitalized patients, adhere to a restrictive transfusion strategy (7–8 g/dL).

  • In intensive care unit patients, consider transfusion when hemoglobin concentrations are ≤7 g/dL.

  • In postoperative surgical patients and patients with preexisting cardiovascular disease, consider transfusion when the hemoglobin concentrations are ≤8 g/dL or when patients are symptomatic.

  • Do not base transfusion decisions solely on hemoglobin levels: Symptoms and clinical context should be taken into account.


The expert panel estimates that widespread use of this restrictive transfusion strategy instead of a liberal strategy could lower patient exposure to red blood cell transfusions by about 40%. Although transfusions are safer now than ever before, a restrictive strategy would lower the incidence of infectious and noninfectious transfusion complications substantially without compromising clinical outcomes. These guidelines should be adopted rapidly, but, as an editorialist notes, the decision to transfuse is quite complex and should not be based on just a number — clinical judgment is paramount.


Reader Comments (2)

Jos� A Garc�a Erce

Please, review the above comment about new AABB transfusion guidelines based on evidence. Really the panel of experts in all their recommendations says "consider"never the figure is mandatory only orientative. Per example, in the first question "In hospitalized, hemodynamically stable patients, at what hemoglobin concentration should a decision to transfuse RBCs be considered?: The AABB recommends adhering to a restrictive transfusion strategy. In adult and pediatric intensive care unit patients, transfusion should be considered at Hb concentrations of 7 g/dL or less."

Competing interests: None declared

Bernard A. Yablin

Does the article refer to whole blood or packed cells only?--Either way there may be a risk of hypervolemia,hypertension, and early CHF if used unwisely.

Competing interests: None declared

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