RBC Transfusions: Should We Go High or Low?
Carson JL, Carless PA, Hébert PC
JAMA. 2013;309:83-84
When should anemic patients be transfused, and what is the best target value for the post-transfusion hemoglobin level? The authors performed a meta-analysis of 9 recent studies in which 30-day mortality was the selected outcome variable. A lower hemoglobin threshold (7-10 g/dL) and a higher threshold (9-13.3 g/dL) were compared in terms of outcomes.
Patients in the lower-threshold group received an average of 1.2 fewer units of blood (95% confidence interval [CI], 0.5-1.8 units). The 30-day relative risk (RR) for death was 15% less for patients in the lower-threshold group (95% CI, 0.70-1.03), and hospital mortality risk was also lower (RR, 0.77; 95% CI, 0.62-0.95).
This report reassures clinicians that hospitalized patients can safely tolerate a hemoglobin level of 7-10 g/dL with no increase in 30-day mortality and an actual decrease in hospital mortality. Many surgical patients were included in the various studies, including those undergoing coronary artery surgery, vascular surgery, or orthopedic surgery; trauma patients; and patients hospitalized for gastrointestinal bleeding. An additional benefit of lowering the transfusion threshold is the reduced strain on blood bank facilities. The current study confirms and updates current clinical practice guidelines.
Abstract
Outcomes Using Lower vs Higher Hemoglobin Thresholds for Red Blood Cell Transfusion
Carson JL, Carless PA, Hébert PC
JAMA. 2013;309:83-84
Summary
When should anemic patients be transfused, and what is the best target value for the post-transfusion hemoglobin level? The authors performed a meta-analysis of 9 recent studies in which 30-day mortality was the selected outcome variable. A lower hemoglobin threshold (7-10 g/dL) and a higher threshold (9-13.3 g/dL) were compared in terms of outcomes.
Patients in the lower-threshold group received an average of 1.2 fewer units of blood (95% confidence interval [CI], 0.5-1.8 units). The 30-day relative risk (RR) for death was 15% less for patients in the lower-threshold group (95% CI, 0.70-1.03), and hospital mortality risk was also lower (RR, 0.77; 95% CI, 0.62-0.95).
Viewpoint
This report reassures clinicians that hospitalized patients can safely tolerate a hemoglobin level of 7-10 g/dL with no increase in 30-day mortality and an actual decrease in hospital mortality. Many surgical patients were included in the various studies, including those undergoing coronary artery surgery, vascular surgery, or orthopedic surgery; trauma patients; and patients hospitalized for gastrointestinal bleeding. An additional benefit of lowering the transfusion threshold is the reduced strain on blood bank facilities. The current study confirms and updates current clinical practice guidelines.
Abstract
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