Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB

Annals of Internal Medicine Link

1. Jeffrey L. Carson, MD;
2. Brenda J. Grossman, MD, MPH;
3. Steven Kleinman, MD;
4. Alan T. Tinmouth, MD;
5. Marisa B. Marques, MD;
6. Mark K. Fung, MD, PhD;
7. John B. Holcomb, MD;
8. Orieji Illoh, MD;
9. Lewis J. Kaplan, MD;
10. Louis M. Katz, MD;
11. Sunil V. Rao, MD;
12. John D. Roback, MD, PhD;
13. Aryeh Shander, MD;
14. Aaron A.R. Tobian, MD, PhD;
15. Robert Weinstein, MD;
16. Lisa Grace Swinton McLaughlin, MD; and
17. Benjamin Djulbegovic, MD, PhD,
18. for the Clinical Transfusion Medicine Committee of the AABB*

+ Author Affiliations

1. From the UMDNJ–Robert Wood Johnson Medical School, New Brunswick, New Jersey; Washington University School of Medicine, Saint Louis, Missouri; AABB, Bethesda Maryland; University of British Columbia, Victoria, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Alabama at Birmingham, Birmingham, Alabama; Fletcher Allen Health Care, Burlington, Vermont; Center for Translational Injury Research and Department of Surgery, University of Texas Medical Center at Houston, Houston, Texas; Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland; Yale Medical Group, New Haven, Connecticut; Mississippi Valley Regional Blood Center and Carver College of Medicine, University of Iowa, Davenport, Iowa; Duke University School of Medicine, Durham, North Carolina; Emory University School of Medicine, Atlanta, Georgia; Englewood Hospital and Medical Center, Englewood, New Jersey; Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Massachusetts Medical School, Worcester, Massachusetts; American Red Cross, Rockville, Maryland; and H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.

Abstract

Description: Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children.

Methods: These guidelines are based on a systematic review of the literature on randomized clinical trials evaluating transfusion thresholds. We performed a literature search from 1950 to February 2011 with no language restrictions. We examined the proportion of patients who received any RBC transfusion and the number of RBC units transfused to describe the effect of restrictive transfusion strategies on RBC use. To determine the clinical consequences of restrictive transfusion strategies, we examined overall mortality, nonfatal myocardial infarction, cardiac events, pulmonary edema, stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay.

Recommendation 1: The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence).

Recommendation 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence).

Recommendation 3: The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence).

Recommendation 4: The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence).

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