Don’t routinely transfuse red blood cells in hemodynamically stable ICU patients with a hemoglobin concentration greater than 70 g/l (a threshold of 75 g/L may be considered for patients undergoing cardiac surgery; a threshold of 80 g/L may be considered for patients undergoing orthopedic surgery, those receiving extracorporeal membrane oxygenation and those with active cardiovascular disease).

Unnecessary transfusion of red blood cells (RBCs) is more harmful than helpful, and wastes a limited resource, which should be reserved for patients with proven indications. Transfusing RBCs at a threshold higher than 70 g/L does not improve survival in ICU patients, and is associated with more complications and higher costs. This has been extensively studied and a restrictive transfusion strategy results in similar or lower mortality compared with higher thresholds, and other complications, including stroke and infections, may also be reduced.

Sources:

Abbasciano RG, Yusuff H, Vlaar APJ, Lai F, Murphy GJ. Blood Transfusion Threshold in Patients Receiving Extracorporeal Membrane Oxygenation Support for Cardiac and Respiratory Failure-A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2021;35(4):1192-1202. PMID: 33046363.

Carson JL, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016 Nov 15;316(19):2025-2035. PMID: 27732721.

Consensus recommendations for red blood cell transfusion practice in critically ill children from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 2018; 19(9): 884-898. PMID: 30180125.

Mistry N, Shehata N, Carmona P, Bolliger D, Hu R, Carrier FM, Alphonsus CS, Tseng EE, Royse AG, Royse C, Filipescu D, Mehta C, Saha T, Villar JC, Gregory AJ, Wijeysundera DN, Thorpe KE, Jüni P, Hare GMT, Ko DT, Verma S, Mazer CD; TRICS Investigators. Restrictive versus liberal transfusion in patients with diabetes undergoing cardiac surgery: An open-label, randomized, blinded outcome evaluation trial. Diabetes Obes Metab. 2022 Mar;24(3):421-431. doi: 10.1111/dom.14591. Epub 2021 Nov 17. PMID: 34747087.