Nav: Home

Updated AABB guidelines for when to perform red blood cell transfusion, optimal length of RBC storage

October 12, 2016

In a report published online by JAMA, Jeffrey L. Carson, M.D., of Rutgers Robert Wood Johnson Medical School, New Brunswick, N.J., and colleagues provide recommendations for the AABB (previously known as the American Association of Blood Banks) for the target hemoglobin level for red blood cell (RBC) transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion.

More than 100 million units of blood are collected worldwide each year, and approximately 13 million RBC units are collected in the United States, yet the indication for RBC transfusion and the optimal length of RBC storage prior to transfusion are uncertain. For RBC transfusion thresholds, the authors summarized and analyzed the results of 31 randomized clinical trials (RCTs) that included 12,587 participants and compared restrictive thresholds (transfusion not indicated until the hemoglobin level is 7-8 g/dl) with liberal thresholds (transfusion not indicated until the hemoglobin level is 9-10 g/dl). The summary estimates across trials demonstrated that restrictive RBC transfusion thresholds were not associated with higher rates of adverse clinical outcomes. For RBC storage duration, 13 RCTs included 5,515 participants randomly allocated to receive fresher blood or standard-issue blood. These RCTs demonstrated that fresher blood did not improve clinical outcomes.

Summary of Findings

It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient. Recommendation 1: a restrictive RBC transfusion threshold in which the transfusion is not indicated until the hemoglobin level is 7 g/dl is recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level is 10 g/dl (strong recommendation, moderate quality evidence).

A restrictive RBC transfusion threshold of 8 g/dl is recommended for patients undergoing orthopedic surgery, cardiac surgery, and those with preexisting cardiovascular disease (strong recommendation, moderate quality evidence). The restrictive transfusion threshold of 7 g/dl is likely comparable with 8 g/dl, but RCT evidence is not available for all patient categories. These recommendations do not apply to patients with acute coronary syndrome, severe thrombocytopenia (patients treated for hematological or oncological reasons who are at risk of bleeding), and chronic transfusion-dependent anemia (not recommended due to insufficient evidence).

Recommendation 2: patients, including neonates, should receive RBC units selected at any point within their licensed dating period (standard issue) rather than limiting patients to transfusion of only fresh (storage length: <10 days) RBC units (strong recommendation, moderate quality evidence).

"Transfusion is a common therapeutic intervention for which there is considerable variation in clinical practice. If clinicians continue to adopt a restrictive transfusion strategy of 7 g/dl to 8 g/dl, the number of RBC transfusions would continue to decrease. In addition, standard practice should be to initiate a transfusion with 1 unit of blood rather than 2 units. This would have potentially important implications for the use of blood transfusions and minimize the risks of infectious and noninfectious complications," the authors write.

"Research in RBC transfusion medicine has significantly advanced the science in recent years and provides high-quality evidence to inform guidelines. A restrictive transfusion threshold is safe in most clinical settings and the current blood banking practices of using standard-issue blood should be continued."
-end-
(doi:10.1001/jama.2016.9185; the study is available pre-embargo to the media at the For the Media website)

Editor's Note: Support for guideline development was provided by the AABB. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

The JAMA Network Journals

Related Transfusion Articles:

Assay of clotting ability accurately predicts need for transfusion in trauma patients
By combining a conventional laboratory measurement of blood clotting time (known as the International Normalized Ratio or INR) with a new test of blood clot strength, based upon thrombelastography (TEG®), researchers at the University of Colorado's Department of Surgery, Denver, are able to quickly and efficiently assess the overall ability of blood to clot and identify trauma patients who were most in need of a massive blood transfusion.
Broadly adopted transfusion practice may not benefit patients without traumatic injury
A study from investigators at Massachusetts General Hospital finds that a blood transfusion practice previously studied only in patients with severe traumatic injuries has been widely adopted within the hospital for surgical patients without traumatic injuries, for whom it may not be beneficial.
How 1000 new genetic variants were discovered in blood groups
1000 new mutations in the blood group genes: that is what physician and former programmer Mattias Möller found in his research study in which he developed new software and investigated blood group genes in 2504 people.
International study proves old blood is as good as new
It's been long thought that when blood transfusions are needed, it may be best to use the freshest blood, but McMaster University researchers have led a large international study proving that it is not so.
Expert panel issues updated guidelines for red blood cell storage time and transfusion use
For most stable hospitalized patients, transfusions of red blood cells stored for any time point within their licensed dating period -- so-called standard issue -- are as safe as transfusions with blood stored 10 days or less, or 'fresh,' according to updated clinical guidelines issued by an expert panel convened by a national organization that has long set standards for blood banking and transfusion practices.
More Transfusion News and Transfusion Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#534 Bacteria are Coming for Your OJ
What makes breakfast, breakfast? Well, according to every movie and TV show we've ever seen, a big glass of orange juice is basically required. But our morning grapefruit might be in danger. Why? Citrus greening, a bacteria carried by a bug, has infected 90% of the citrus groves in Florida. It's coming for your OJ. We'll talk with University of Maryland plant virologist Anne Simon about ways to stop the citrus killer, and with science writer and journalist Maryn McKenna about why throwing antibiotics at the problem is probably not the solution. Related links: A Review of the Citrus Greening...