Jeffrey L. Carson, MD; Brenda J. Grossman, MD, MPH; Steven Kleinman, MD; Alan T. Tinmouth, MD; Marisa B. Marques, MD; Mark K. Fung, MD, PhD; John B. Holcomb, MD; Orieji Illoh, MD; Lewis J. Kaplan, MD; Louis M. Katz, MD; Sunil V. Rao, MD; John D. Roback, MD, PhD; Aryeh Shander, MD; Aaron A.R. Tobian, MD, PhD; Robert Weinstein, MD; Lisa Grace Swinton McLaughlin, MD; Benjamin Djulbegovic, MD, PhD; for the Clinical Transfusion Medicine Committee of the AABB
Note: Guidelines cannot account for individual variation among patients. They are not intended to supplant physician judgment with respect to specific patients or special clinical situations. Accordingly, the AABB considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's unique circumstances.
Financial Support: Support for the development of this guideline was provided by the AABB, Bethesda, Maryland.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-3065.
Requests for Single Reprints: Jeffrey L. Carson, MD, Division of General Internal Medicine, UMDNJ–Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08903; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Carson: UMDNJ–Robert Wood Johnson Medical School, Division of General Internal Medicine, 125 Paterson Street, 2nd Floor, New Brunswick, NJ 08903-0019.
Dr. Grossman: Washington University, Department of Pathology and Immunology, Campus Box 8118, 660 South Euclid Avenue, Saint Louis, MO 63110.
Dr. Kleinman: University of British Columbia, 1281 Rockcrest Avenue, Victoria, British Columbia V9A 4W4, Canada.
Dr. Tinmouth: Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Dr. Marques: University of Alabama at Birmingham, 619 19th Street South, West Pavilion, P230G, Birmingham, AL 35249.
Dr. Fung: Fletcher Allen Health Care, 111 Colchester Avenue, Burlington, VT 05401.
Dr. Holcomb: University of Texas Medical Center at Houston, 6410 Fannin Street, UPB 1100, Houston, TX 77030.
Dr. Illoh: U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Division of Blood Applications, HFM-375, 1401 Rockville Pike, Rockville, MD 20852.
Dr. Kaplan: Yale University, 330 Cedar Street, BB-310, New Haven, CT 06520.
Dr. Katz: Mississippi Valley Regional Blood Center, 5500 Lakeview Parkway, Davenport, IA 52807.
Dr. Rao: Duke University, 508 Fulton Street (111A), Durham, NC 27705.
Dr. Roback: Emory University School of Medicine, EUH D-655, 1364 Clifton Road Northeast, Atlanta, GA 30322.
Dr. Shander: Englewood Hospital and Medical Center, 350 Engle Street, Englewood, NJ 07631.
Dr. Tobian: Johns Hopkins University, Carnegie 667, 600 North Wolfe Street, Baltimore, MD 21287.
Dr. Weinstein: University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.
Dr. McLaughlin: American Red Cross, Biomedical Headquarters, Holland Laboratory, 15601 Crabbs Branch Way, E230, Rockville, MD 20855.
Dr. Djulbegovic: University of South Florida, 12901 Bruce B. Downs Boulevard, MDC02, Tampa, FL 33612.
Author Contributions: Conception and design: J.L. Carson, S. Kleinman, M.B. Marques, M.K. Fung, J.B. Holcomb, L.J. Kaplan, L.M. Katz, J.D. Roback, A. Shander, A.A.R. Tobian, B. Djulbegovic.
Analysis and interpretation of the data: J.L. Carson, B.J. Grossman, S. Kleinman, A.T. Tinmouth, M.B. Marques, M.K. Fung, L.J. Kaplan, L.M. Katz, S.V. Rao, J.D. Roback, A. Shander, A.A.R. Tobian, R. Weinstein, L.G.S. McLaughlin, B. Djulbegovic.
Drafting of the article: J.L. Carson, B.J. Grossman, S. Kleinman, A.T. Tinmouth, M.K. Fung, J.B. Holcomb, O. Illoh, J.D. Roback, A. Shander, A.A.R. Tobian, B. Djulbegovic.
Critical revision of the article for important intellectual content: J.L. Carson, B.J. Grossman, S. Kleinman, A.T. Tinmouth, M.B. Marques, M.K. Fung, J.B. Holcomb, O. Illoh, L.J. Kaplan, L.M. Katz, S.V. Rao, J.D. Roback, A. Shander, A.A.R. Tobian, R. Weinstein, B. Djulbegovic.
Final approval of the article: J.L. Carson, B.J. Grossman, A.T. Tinmouth, M.B. Marques, M.K. Fung, J.B. Holcomb, O. Illoh, L.J. Kaplan, L.M. Katz, S.V. Rao, J.D. Roback, A. Shander, A.A.R. Tobian, R. Weinstein, L.G.S. McLaughlin, B. Djulbegovic.
Provision of study materials or patients: J.L. Carson.
Statistical expertise: J.L. Carson, B. Djulbegovic.
Administrative, technical, or logistic support: M.K. Fung, B. Djulbegovic.
Collection and assembly of data: J.L. Carson, M.B. Marques, L.J. Kaplan, L.M. Katz, A.A.R. Tobian, L.G.S. McLaughlin.
Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children.
These guidelines are based on a systematic review of randomized clinical trials evaluating transfusion thresholds. We performed a literature search from 1950 to February 2011 with no language restrictions. We examined the proportion of patients who received any RBC transfusion and the number of RBC units transfused to describe the effect of restrictive transfusion strategies on RBC use. To determine the clinical consequences of restrictive transfusion strategies, we examined overall mortality, nonfatal myocardial infarction, cardiac events, pulmonary edema, stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay.
The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence).
The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence).
The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence).
The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence).
Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al. Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB*. Ann Intern Med. ;157:49–58. doi: 10.7326/0003-4819-157-1-201206190-00429
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Published: Ann Intern Med. 2012;157(1):49-58.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Guidelines.
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