Updated Blood Transfusion Guidelines Back a Conservative Approach

Updated guidelines from the AABB (formerly, American Association of Blood Banks), published in JAMA, recommend a conservative strategy for blood transfusion.

The recommendations, an update from the group’s 2012 guidance, are based on an analysis of 31 randomized trials comparing a restrictive strategy (triggered by a hemoglobin concentration 7–8 g/dL) with a liberal strategy (9–10 g/dL). The analysis found no increase in adverse outcomes with the restrictive approach.

Here are the new recommendations:

• For hospitalized adults who are hemodynamically stable (including critically ill patients) transfusion is now indicated only when the hemoglobin level hits 7 g/dL.
• For patients undergoing orthopedic or cardiac surgery and those with cardiovascular disease, the transfusion threshold should be 8 g/dL.

In addition, an analysis of 13 randomized trials found similar outcomes with standard-issue versus fresher blood. Accordingly, the new guidelines recommend using standard-issue blood rather than limiting transfusions to fresher blood (<10 days’ storage).

Of note, the guidelines don’t apply to patients with acute coronary syndromes, severe thrombocytopenia, and chronic transfusion-dependent anemia.