Restrictive Red Blood Cell Transfusion Strategy Recommended In New Guidelines

Editor's Choice Academic Journal Main Category: Blood / Hematology Article Date: 27 Mar 2012 - 6:00 PDT

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According to the 20-member panel of experts, in many settings patients are receiving unnecessary transfusions in the United States.

Jeffery L. Carson, M.D., Chief of the Division of General Internal Medicine at UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, and lead author of the guideline, explained:

In order to determine the best use of red blood cells to maximize clinical outcomes and to prevent the harms and costs of unnecessary transfusions, the team of researchers based their evaluation on a systematic review of studies published from 1950 to 2011.

To determine the impact of restrictive transfusion strategies on red blood cell usage, the team analyzed the ratio of individuals who underwent any red cell transfusion. In addition, they also determined the clinical outcome of a restrictive strategy by analyzing overall cardiac events, mortality, non-fatal heart attack, stroke, pulmonary edema, renal failure, thromboembolism, hemorrhage, length of hospitalization, functional recovery, infection, and mental confusion.

For patients with pre-existing heart disease, they recommend sticking to a restrictive transfusion strategy, while patients with symptoms of anemia or a hemoglobin of less than or equal to 8 g/DL should be considered for transfusion.

However, the experts warn that there was some concern regarding risk for perioperative heart attack linked to this strategy. For individuals suffering with acute coronary syndrome, they did not find enough evidence to recommend a liberal or restrictive transfusion strategy.

Although physicians prevalently use hemoglobin concentration in order to determine when to transfuse, they should also consider symptoms of anemia in their decision-making, according to the experts.

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Restrictive Red Blood Cell Transfusion Strategy Recommended In New Guidelines