AABB releases new guidelines for red blood cell transfusion

AABB (formerly known as the American Association of Blood Banks) recommends a restrictive red blood cell transfusion strategy for stable adults and children, according to new guidelines being published in Annals of Internal Medicine. Physicians should consider transfusing at a hemoglobin threshold of 7 to 8 g/dL, as the evidence shows no difference in mortality, ability to walk independently, or length of hospital stay between patients on a liberal transfusion strategy or a restrictive strategy. Wide variability in the use of transfusions in the United States indicates that in many settings patients are receiving unnecessary transfusions.

"Our recommendation is based on the evidence that restrictive transfusion is safe and associated with less blood use," said Jeffrey L. Carson, MD, Chief of the Division of General Internal Medicine at UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, and lead author of the guideline. "Of course, is critical. Physicians may choose to transfuse above or below the specified hemoglobin threshold based on individual patient characteristics."

A 20-member panel of experts based their assessment on a systematic review of research published from 1950 to 2011 to determine optimal use of to maximize clinical outcomes and avoid the harms and costs of unnecessary transfusions. The researchers examined the proportion of patients who received any red and the number of red cell units transfused to describe the impact of restrictive transfusion strategies on red blood cell usage. To determine the clinical consequences of a restrictive strategy, the researchers examined overall mortality, non-fatal myocardial infarction, cardiac events, , stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay.

Based on the evidence, the panel also suggests adhering to a restrictive transfusion strategy for patients with preexisting cardiovascular disease. Physicians should consider transfusion for patients with symptoms of anemia or a hemoglobin of less than or equal to 8 g/dL. However, the researchers caution that there was some uncertainty about risk for perioperative associated with this approach. The panel found insufficient evidence to recommend a liberal or restrictive transfusion strategy for patients with acute coronary syndrome.

While physicians most commonly use hemoglobin concentration to decide when to transfuse, the panel suggests that physicians also consider symptoms of anemia in their decision-making.

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Humiliation tops list of mistreatment toward med students

2 hours ago

Each year thousands of students enroll in medical schools across the country. But just how many feel they've been disrespected, publicly humiliated, ridiculed or even harassed by their superiors at some point during their ...

Surrogate offers clues into man with 16 babies

10 hours ago

When the young Thai woman saw an online ad seeking surrogate mothers, it seemed like a life-altering deal: $10,000 to help a foreign couple that wanted a child but couldn't conceive.

Nurses go on strike in Ebola-hit Liberia

11 hours ago

Nurses at Liberia's largest hospital went on strike on Monday, demanding better pay and equipment to protect them against a deadly Ebola epidemic which has killed hundreds in the west African nation.

ALS Ice Bucket Challenge arrives in North Korea

Aug 31, 2014

It's pretty hard to find a novel way to do the ALS Ice Bucket Challenge by now, but two-time Grammy-winning rapper Pras Michel, a founding member of the Fugees, has done it—getting his dousing in the center ...

Cold cash just keeps washing in from ALS challenge

Aug 28, 2014

In the couple of hours it took an official from the ALS Association to return a reporter's call for comment, the group's ubiquitous "ice bucket challenge" had brought in a few million more dollars.

User comments