Choosing Wisely:

Don’t administer packed red blood cells in a young healthy patient without ongoing blood loss and hemoglobin of ≥ 6 g/dL unless symptomatic or hemodynamically unstable.

Rationale and Comments: The hemoglobin transfusion threshold used in multiple studies has varied from 6.0 to 10.0 g/dL. The optimal hemoglobin/hematocrit criterion for transfusion remains controversial in several clinical settings. Nevertheless, compared with higher hemoglobin thresholds, a lower hemoglobin threshold is associated with fewer red blood cell units transfused without adverse associations with mortality, cardiac morbidity, functional recovery, or length of hospital stay. Hospital mortality remains lower in patients randomized to a lower hemoglobin threshold for transfusion versus those randomized to a higher hemoglobin threshold. The decision to transfuse should be based on a combination of both clinical and hemodynamic parameters.
Sponsoring Organizations:
  • American Society of Anesthesiologists
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Hematologic
  • References: • American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies. Anesthesiology. 2006 Jul;105(1):198-208.
    • Carson JL, Carless PA, Hebert PC. Outcomes using lower versus higher hemoglobin thresholds for red blood cell transfusion. JAMA. 2013;309(1):83-4.
    • Carson JL, Patel MS. (2013). Is there an optimal perioperative hemoglobin level? In: Fleisher L. Evidence-based practice of anesthesiology (3rd ed., pp. 155–163). Philadelphia (PA): Elsevier Saunders.
    • Goodnough LT, Levy JH, Murphy MF. Concepts of blood transfusion in adults. Lancet. 2013;381(9880):1845-54.
    • Carson JL, Carless PA, Hebert PC. Transfusion threshold and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012;4:CD002042.
    • Bittencourt R, Costa J, Lobo JE, Aquiar FC. Consciously transfusion of blood products. Systematic review of indicative factors for blood components infusion trigger. Rev Bras Anestesiol. 2012;62(3):402-10.
    • 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 Committee of the AABB. Red blood cell transfusion: a clinical perspective guideline from the AABB. Ann Intern Med. 2012;157(1):49-58.
    • Toy P, Feiner J, Viele MK, Watson J, Yeap H, Weiskopf RB. Fatigue during acute isovolemic anemia in healthy resting humans. Transfusion. 2000;40(4):457–60.

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