Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB

Study Questions:

What are the clinical recommendations about hemoglobin concentration thresholds and other clinical variables that should trigger red blood cell transfusions in hemodynamically stable adults and children?


The authors performed a systematic review of the clinical trials evaluating transfusion thresholds, and provided four recommendations.


Recommendation 1: The AABB (formerly, the American Association of Blood Banks) recommends adhering to a restrictive transfusion strategy (7-8 g/dl) in hospitalized, stable patients.

Recommendation 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with pre-existing cardiovascular disease, and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dl or less.

Recommendation 3: The AABB does not recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome, since there are no high-quality data to help guide transfusion policy in these patients.

Recommendation 4: Transfusion decisions should be influenced by symptoms as well as hemoglobin concentration.


These guidelines should help reduce unnecessary transfusion in stable patients. Further, this study highlighted the lack of evidence in patients who have acute coronary syndrome, and this should spur randomized efforts to define the best strategy in anemic patients with acute coronary syndrome.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology

Keywords: Child, Blood Transfusion, Erythrocyte Transfusion, Transfusion Medicine, Platelet Transfusion, Cardiovascular Diseases, Blood Banks, United States

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