Authors: Holst LB et al., BMJ 2015 Mar 24; 350:h1354
A growing body of evidence suggests that restrictive red blood cell transfusion strategies are safe. In this systematic review and meta-analysis of 31 randomized trials that involved 9800 patients, researchers compared benefits and harms of restrictive (triggers: hemoglobin, 7–9 g/dL; hematocrit, 24%–30%, or symptoms of anemia) versus liberal (triggers: hemoglobin, 9–13 g/dL; hematocrit, 30%–40%) red blood cell transfusion strategies.
Risks for death, overall morbidity, fatal and nonfatal myocardial infarction, stroke, and kidney failure did not differ between patients randomized to restrictive transfusion strategies and those randomized to liberal strategies. However, patients randomized to restrictive transfusion strategies had fewer infectious complications than those randomized to liberal strategies (relative risk, 0.8). The proportions of patients who received transfusions were significantly lower in the restrictive groups than in the liberal groups (RR, 0.5). Likewise, the mean number of units of red cells transfused was significantly lower in the restrictive groups than in the liberal groups (mean difference, −1.43).
This meta-analysis convincingly shows that restrictive red blood cell transfusion strategies are safe and are associated with lower use of scarce healthcare resources (i.e., units of red blood cells and expertise, time, and equipment needed to acquire and transfuse them). In contrast, liberal strategies can cause harm (e.g., infectious complications).