Choosing Wisely:

Don’t transfuse more than the minimum of red blood cell units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable patients).

Rationale and Comments: Unnecessary transfusion exposes patients to potential adverse effects without any likelihood of benefit and generates additional costs. Transfusion decisions should be influenced by a person’s symptoms and hemoglobin concentration
Sponsoring Organizations:
  • American Academy of Family Physicians
  • Sources:
  • AABB guidelines
  • Disciplines:
  • Hematologic
  • References: • American Society of Hematology Choosing Wisely Recommendation: Don’t transfuse more than the minimum number of red blood cell units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac in-patients). http://www.choosingwisely.org/societies/american-society-of-hematology.
    • 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 practice guideline from the AABB. Ann Intern Med. 2012;157(1):49-58.
    • Retter A, Wyncoll D, Pearse R, Carson D, McKechnie S, Stanworth S, Allard S, Thomas D, Walsh T; British Committee for Standards in Hematology. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol. 2013;160(4):445-64.
    • American Association of Blood Banks Choosing Wisely recommendation: Don’t transfuse more units of blood than absolutely necessary http://www.choosingwisely.org/societies/american-association-of-blood-banks.
    • 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 practice guideline from the AABB. Ann Intern Med. 2012;157(1):49-58.
    • Canada’s Choosing Wisely Recommendation: Don’t transfuse patients based solely on an arbitrary hemoglobin threshold. https://choosingwiselycanada.org/hematology/.
    • Callum J, et al. Bloody easy 3, blood transfusions, blood alternatives and transfusion reactions, a guide to transfusion medicine. 3rd ed. Toronto (ON): Sunnybrook and Women’s College Health Sciences Centre; 2011.
    • Choosing Wisely Canada. Canadian Society of Internal Medicine: Five Things Physicians and Patients Should Question [Internet]. 2014 [cited 2014 Aug 26].
    • Carson JL, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med. 2012;157(1):49-58.
    • Hebert PC, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340(6):409-417.
    • Hicks LK, et al. The ASH Choosing Wisely(R) campaign: five hematologic tests and treatments to question. Blood. 2013;122(24):3879-3883.

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