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Red blood cell transfusion: a clinical practice guideline from the AABB*.

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 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).

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Carson JL,Grossman BJ,Kleinman S,Tinmouth AT,Marques MB,Fung MK,Holcomb JB,Illoh O,Kaplan LJ,Katz LM,Rao SV,Roback JD,Shander A,Tobian AA,Weinstein R,Swinton McLaughlin LG,Djulbegovic B,Clinical Transfusion Medicine Com

doi

10.7326/0003-4819-157-1-201206190-00429

subject

Has Abstract

pub_date

2012-07-03 00:00:00

pages

49-58

issue

eissn

0003-4819

issn

1539-3704

pii

1206681

journal_volume

157

pub_type

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Red blood cell transfusion: a clinical practice guideline from the AABB*.