Transfusion thresholds for guiding allogeneic red blood cell transfusion

Transfusions with allogeneic red blood cells in anaemic patients with haemoglobin thresholds above 7 g/dL to 8 g/dL is effective in decreasing the proportion of participants exposed to red blood cell transfusion by 43% across a broad range of clinical specialities compared with a transfusion threshold of 9 g/dL to 10 g/dL, without affecting 30-day mortality or morbidity (i.e. cardiac events, stroke, pneumonia, and thromboembolism).

Comment: There were insufficient data of the safety of transfusion in certain clinical subgroups, including acute myocardial infarction, neurological injury/traumatic brain injury, stroke, thrombocytopenia, cancer, haematological malignancies, and bone marrow failure

Summary

A Cochrane review included 31 studies with a total of 12 587 subjects assessing the optimal haemoglobin threshold for the use of red blood cell (RBC) transfusions in anaemic patients (across a range of clinical specialities e.g. surgery, critical care). The restrictive transfusion threshold used a lower haemoglobin level to trigger transfusion (most commonly 7 g/dL or 8 g/dL), and the liberal transfusion threshold uses a higher haemoglobin level to trigger transfusion (most commonly 9 g/dL to 10 g/dL). Restrictive strategies reduced the risk of receiving a RBC transfusion by 43% across a broad range of clinical specialties (table ). Overall, restrictive transfusion strategies compared with liberal transfusion strategies did not increase or decrease the risk of 30-day mortality or any of the other outcomes assessed (i.e. cardiac events, myocardial infarction, stroke, thromboembolism, pneumonia, wound, or bacteraemia) (table ).

Clinical comments

Date of latest search: 27 May 2016

Ədəbiyyat

1. Carson JL, Stanworth SJ, Roubinian N et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2016;(10):CD002042.