New Guidelines Issued for Red Blood Cell Transfusions

Restrictive approach recommends transfusion at hemoglobin threshold of 7 to 8 g/dL in stable patients

MONDAY, March 26 (HealthDay News) -- A restrictive red blood cell transfusion strategy should be employed for hemodynamically stable adults and children, according to a clinical practice guideline issued by the AABB (formerly the American Association of Blood Banks) and published online March 26 in the Annals of Internal Medicine.

Jeffrey L. Carson, M.D., of the University of Medicine and Dentistry New Jersey-Robert Wood Johnson Medical School in New Brunswick, and colleagues on the AABB Clinical Transfusion Medicine Committee conducted a systematic review of the literature (1950 to February 2011) for randomized clinical trials evaluating transfusion thresholds. The guidelines were developed to provide evidence-based recommendations regarding hemoglobin concentration thresholds and other clinical variables that trigger red blood cell transfusions in adults and children who are hemodynamically stable.

The authors recommend adhering to a restrictive transfusion strategy (7 to 8 g/dL) for hospitalized, stable patients, and also suggest adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease. For patients with symptoms or a hemoglobin level of 8 g/dL or less, they recommend transfusion be considered. Due to very low-quality evidence, for hospitalized, hemodynamically stable patients with acute coronary syndrome, the authors do not recommend for or against liberal or restrictive transfusion thresholds. The committee also suggests that transfusion decisions be influenced by symptoms in addition to hemoglobin concentration.

"Clinicians make decisions every day with incomplete evidence. We believe these guidelines provide a carefully considered set of recommendations that incorporate the quality of the evidence, benefits and risks of transfusion, and joint judgment of an expert panel from many subspecialties," the authors write.

The authors disclosed financial ties to the pharmaceutical and medical technology industries; providing testimony for law firms in defense of blood collection facilities; and/or employment as the Director of Blood Bank/Transfusion Services at Fletcher Allen Health Care.

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