Safe to Stall Transfusions

Delaying red blood cell transfusions remains safe for patients

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Doctors have long debated the appropriate timing for a red blood cell transfusion. Is it better to wait until the last minute when patients are in the most need? Or should doctors be proactive and transfuse early? Which is safer?

A new review concluded that patients who received delayed transfusions were not more likely to die, as compared to individuals who received transfusions at a more liberal threshold.

"Ask your doctor about transfusion procedures before surgery."

Jeffrey L. Carson, MD, the Richard C. Reynolds Professor of Medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, said the review study found a restrictive approach to transfusions is safe for most patients, including those with anemia.

Dr. Carson was one of the many specialists who helped develop transfusion guidelines approved by the AABB, formerly the American Association of Blood Banks, less than a year ago. The guidelines suggest that doctors consider red blood cell transfusions at a hemoglobin threshold of 7 to 8 g/dL. Hemoglobin is the protein in red blood cells that carries the oxygen.

During the study, researchers reviewed more than 6,000 patients with an average age of 63 who had participated in one of 19 studies. Following the review, they concluded that patients who received delayed transfusions were not more likely to die, as compared to individuals who received transfusions at a more liberal threshold.

Investigators also found there was not a significant difference in major complications such as pneumonia, stroke, infection or pulmonary edema, which is a buildup of fluid in the air sacs of the lungs, which leads to shortness of breath.

A study previously published in journal Anesthesiology in April, about a month after the approval of the guidelines, found that red blood cell transfusions were still being overused.

Steven M. Frank, MD, leader of that study and an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, said that giving blood transfusions less frequently could improve outcomes for patients, reduce risks, and also cut medical costs.

Though he said there is no exact science to determining when to give blood, since surgeries and other circumstances can vary, striving to use less blood when possible would benefit patients.

Dr. Carson's review study was recently published in JAMA Clinical Evidence Synopsis, a section of the Journal of the American Medical Association.

Reviewed by: 
Review Date: 
January 2, 2013
Last Updated:
January 3, 2013