NEW BRUNSWICK – The transfusion of red blood cells is a common treatment in clinical practice. However, the level at which they are transfused varies based not only on a patient’s health, but also is determined by what the administering physician deems appropriate.
Today, the American Association of Blood Banks (AABB) has issued new guidelines, published in Annals of Internal Medicine, recommending that transfusion of red blood cells be considered at a hemoglobin threshold of 7 to 8 g/dL for stable adults and children. This recommendation to use a restrictive approach not only saves blood, but also reduces the costs related to unnecessary transfusions.
“A systematic review of published research determined that a restrictive approach to red blood cell transfusions would provide the best clinical outcomes for patients without causing harm,” said Jeffrey L. Carson, the Richard C. Reynolds Professor of Medicine at UMDNJ-Robert Wood Johnson Medical School, who chaired the guideline committee and is the first author of the guidelines found at Clinical Practice Guideline on Red Blood Cell Transfusion. “It is important however that physicians consider other clinical conditions when determining transfusion levels to ensure patient safety.”
The AABB recommendations – four in all – are based on the systematic review of research published from 1950 to 2011 which examines the proportion of patients, both adult and children, who received any red blood cell transfusion for medical or surgical reasons, and the number of red blood cell units transfused. The guidelines also recommend a restrictive transfusion approach for patients with preexisting cardiovascular disease but indicate that it is unknown when transfusion should be given to a patient hospitalized for a heart attack. The fourth guideline recommends that the patient’s symptoms, in addition to hemoglobin levels, be considered when determining transfusion levels.
Dr. Carson was the study chair for the Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair, known as FOCUS, the results of which were published in December 2011 in the New England Journal of Medicine. The results of FOCUS contributed to these guidelines as did two previously published systematic reviews of research by Dr. Carson and colleagues.
Dr. Carson developed the guidelines along with specialists in cardiology, pediatrics, critical care medicine, trauma and anesthesia who formed a 20-member panel of experts.
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