New guideline’s published in Annals of Internal Medicine by the AABB (formerly known as the American Association of Blood Banks), recommends a restrictive red blood cell transfusion strategy for stable adults and children. Between patients on a restrictive strategy or a liberal transfusion strategy, evidence shows no difference in the length of hospitalization, ability to walk unaided, or in mortality, and therefore physicians should consider transfusing at a hemoglobin threshold of 7 to 8g/dL.

According to the 20-member panel of experts, in many settings patients are receiving unnecessary transfusions in the United States.

Jeffery L. Carson, M.D., Chief of the Division of General Internal Medicine at UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, and lead author of the guideline, explained:

“Our recommendation is based on the evidence that restrictive transfusion is safe and associated with less blood use. Of course, clinical judgement is critical. Physicians may choose to transfuse above or below the specified hemoglobin threshold bases on individual patient characteristics.”

In order to determine the best use of red blood cells to maximize clinical outcomes and to prevent the harms and costs of unnecessary transfusions, the team of researchers based their evaluation on a systematic review of studies published from 1950 to 2011.

To determine the impact of restrictive transfusion strategies on red blood cell usage, the team analyzed the ratio of individuals who underwent any red cell transfusion. In addition, they also determined the clinical outcome of a restrictive strategy by analyzing overall cardiac events, mortality, non-fatal heart attack, stroke, pulmonary edema, renal failure, thromboembolism, hemorrhage, length of hospitalization, functional recovery, infection, and mental confusion.

For patients with pre-existing heart disease, they recommend sticking to a restrictive transfusion strategy, while patients with symptoms of anemia or a hemoglobin of less than or equal to 8 g/DL should be considered for transfusion.

However, the experts warn that there was some concern regarding risk for perioperative heart attack linked to this strategy. For individuals suffering with acute coronary syndrome, they did not find enough evidence to recommend a liberal or restrictive transfusion strategy.

Although physicians prevalently use hemoglobin concentration in order to determine when to transfuse, they should also consider symptoms of anemia in their decision-making, according to the experts.

Written by Grace Rattue