The authors of the current AABB guidelines recognized the importance of replicating the current findings in a more diverse patient population. An area where further study is indicated is in the use of specific transfusion thresholds in patients with acute coronary syndrome. These guidelines did not clarify whether or not there is a physiologic difference between use of different restrictive transfusion thresholds such as <8g/dL and <7g/dL.
The authors of the AABB guidelines also commented that performing a future trial to compare RBC transfusion for symptoms vs. hemoglobin “trigger” would be useful; however, they recognized that this may not be feasible due to the need to blind providers in the trial to hemoglobin values. Various society guidelines currently call for different transfusion thresholds or do not make a specific recommendation at all.1
Key Takeaways for Hospitalists
For the vast majority of medical patients, hospitalists can safely use a restrictive RBC transfusion threshold (≤7g/dL or ≤8g/dL), which can lead to a significant decrease in RBC transfusions without adversely affecting overall mortality.
Drs. Bortinger and Carbo are hospitalists at Beth Israel Deaconess Medical Center in Boston.
References
- Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Inter Med. 2012;157(1):49-58.
- Carson AL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;367(26):2453-2462.
- Hajjar LA, Vincent JL, Galas FR, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010;304(14):1559-1567.
- Carson JL, Carless PA, Herbert PC. Transfusion threshold and other strategies for guiding allogenic red blood cell transfusion. Cochrane Database Syst Rev. 2012;CD002042.
- Napolitano LM, Kurek S, Luchette FA, et al. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Crit Care Med. 2009;37(12):3124-3157.