Restricting Transfusions Safe

Red blood cell transfusion restrictions safe and recommended

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

(RxWiki News) U.S. blood bank officials are recommending more restrictive guidelines for red blood cell transfusions because evidence shows lowering the threshold still protects the health of patients.

Red blood cell transfusions are different from standard blood transfusions in that red blood cells are separated from whole blood. These types of transfusions are typically used to restore oxygen carrying capacity of the blood for conditions such as anemia.

"Talk to your doctor about the appropriate time for a transfusion."

Dr. Jeffrey L. Carson, chief of the division of general internal medicine at UMDNJ-Robert Wood Johnson Medical School, said the recommendation was based on evidence showing restrictive transfusion is safe and uses less blood. Restrictive transfusion policies refer to offering transfusions at a lower threshold, rather than using them as a first-line defense.

He noted that clinical physician judgment still would be critical. Doctors could choose to offer transfusions above or below the recommended level based on the needs of individual patients.

AABB, which was formerly known as the American Association of Blood Banks, now suggests 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.

Guideline authors, comprised of 20 experts, said that evidence suggests no differences in patient mortality, hospital stay length or ability to walk independently, regardless of whether patients receive red blood cell transfusions on a restrictive or liberal transfusion plan. They indicated that many U.S. patients may be receiving unnecessary transfusions.

The findings were based on a systematic review of research that sought to determine the optimal use of red blood cells to improve clinical outcomes, keep patients safe and skip unneeded transfusions. The studies they reviewed were published between 1950 and 2011

In identifying the threshold, researchers examined the proportion of patients receiving the transfusions and the number of red cell units transfused. They then studied the outcomes, including death rate, heart attacks or other cardiovascular events, stroke, renal failure, infection, hemorrhage, hospital stay and functional recovery.

Panel members suggested the guidelines remain appropriate for patients with pre-existing cardiovascular disease, though it did not have sufficient data to make a recommendation for patients with acute coronary syndrome.

They suggest patients with anemia or hemoglobin equal to or less than 8 g/dL be considered for transfusions, though they noted this approach could come with an increased risk of heart attacks after surgery that was not cardiovascular related.

The guidelines were published in journal Annals of Internal Medicine.

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Review Date: 
March 21, 2012
Last Updated:
March 26, 2012