Rationale and evidence
Rationale
Every unit of blood transfused presents benefits and risks to the patients. Risks associated with transfusion include:
- febrile reactions
- allergic reactions and anaphylaxis
- haemolytic reactions
- transfusion-transmitted infections
- transfusion-associated acute lung injury, transfusion-associated circulatory overload
- alloimmunisation.
Each unit transfused must have a clear indication and unnecessary transfusions must be avoided.
A restrictive transfusion strategy (Haemoglobin (Hb) of 70-80g/L) should be used for the majority of hospitalised, stable (non-bleeding) adult patients. The decision to give a red blood cell transfusion should not be dictated by Hb alone and should also include an assessment of the patient’s underlying condition, any clinical signs and symptoms and response to previous transfusions.
A single unit of red cell transfusions is the standard of care for non-bleeding, hospitalised patients. Additional units should only be prescribed after clinical re-assessment of the patient and their haemoglobin value.
Evidence
Hill S, Carless PA, Henry DA, et al 2016, Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion, Cochrane Database of Systematic Reviews. Oct 16; 2016, Issue 10.
Carson JL, Terrin ML, Noveck H, et al, Liberal or restrictive transfusion in high-risk patients after hip surgery, N Engl J Med. 2011 365(26): 2453–2462.
Gu WJ, Gu XP, Wu XD, et al 2018, Restrictive versus liberal strategy for red blood-cell transfusion a systematic review and meta-analysis in orthopaedic patients, J Bone and Joint Surgery. 100-A(8): 686-695.
Kheiri B, Abdalla A, Osman M, et al 2019, Restrictive versus liberal red blood cell transfusion for cardiac surgery: a systematic review and meta-analysis of randomised controlled trials. Journal of Thrombosis and Thrombolysis. 47(2): 179-185.
LaCroix et al,’ Transfusion strategies for patients in pediatric intensive care units’, N Engl J Med. 2007 Apr 19;356(16): 1609-19.
Mazer CD, Whitlock RP, Fergusson DA, et al 2018, Six-month outcomes after restrictive or liberal transfusion for cardiac surgery, N Engl J Med. 2018 379: 1224-33.
Szczepiorkowski ZM & Dunbar NM, Transfusion guidelines: when to transfuse, Hematology Am. Soc. Hematol. Educ. Program. 2013; 2013: 638-644.
Villanueva C, Colomo A, Bosch A, et al 2013, Transfusion strategies for acute upper gastrointestinal bleeding, N Engl J Med. 2013 368:11-21.
Zhang W, Zheng Y, Yu K, et al 2020, Liberal transfusion versus restrictive transfusion and outcomes in critically ill adults: a meta-analysis, Transfusion Medicine and Hemotherapy. 2020