Indications for blood transfusion depend on clinical assessment and are also guided by the etiology of the anemia. No single laboratory measurement or physiologic parameter can predict the need for blood transfusion. Transfusions are associated with increased morbidity and mortality in high-risk hospitalized inpatients. Adverse events range from mild to severe, including allergic reactions, acute hemolytic reactions, anaphylaxis, transfusion related acute lung injury, transfusion associated circulatory overload, and sepsis. Studies of transfusion strategies among multiple patient populations suggest that a restrictive approach is associated with improved outcomes.
Sources:
Bracey AW, et al. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: Effect on patient outcome. Transfusion. 1999 Oct;39(10):1070-7. PMID: 10532600.
Carson JL, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012 Apr 18;4:CD002042. PMID: 22513904.
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 Feb 11;340(6):409-17. PMID: 10318985.
Marik PE, et al. Efficacy of red blood cell transfusion in the critically ill: A systematic review of the literature. Crit Care Med. 2008 Sep;36(9):2667-74. PMID: 18679112.
Villanueva C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013 Jan 3;368(1):11-21. PMID: 26013300.
Related Resources:
Toolkit: Why Give Two When One Will Do – A toolkit for reducing unnecessary red blood cell transfusions in hospitals