From the Guidelines
Hemoglobin Transfusion Thresholds
For most patient populations, a hemoglobin transfusion threshold of 7-8 g/dL is recommended 1.
- This restrictive transfusion strategy is based on data from randomized trials and is applicable to hemodynamically stable critical care, surgical, and medical patients.
- For patients with cardiovascular disease, a slightly more liberal threshold may be considered, but the evidence is not sufficient to make specific recommendations 1.
- The decision to transfuse should be guided by individual patient factors, rather than relying solely on a hemoglobin trigger 1.
- Implementing a restrictive transfusion strategy can decrease exposure to RBC transfusions by approximately 40% and reduce the risks of infectious and noninfectious complications of transfusion 1.
- Other guidelines, such as those from the American Society of Anesthesiologists and the British Committee for Standards in Haematology, have also recommended restrictive transfusion strategies, with thresholds ranging from 6 to 10 g/dL 1.
- The goal of transfusion is to increase hemoglobin levels to a safe range, typically above 8-10 g/dL, while minimizing the risks associated with transfusion.
From the Research
Hemoglobin Transfusion Thresholds
The hemoglobin (Hb) transfusion thresholds are as follows:
- For hospitalized adult patients who are hemodynamically stable, a restrictive transfusion strategy is recommended, considering transfusion when the hemoglobin concentration is less than 7 g/dL 2, 3
- For patients undergoing cardiac surgery, a threshold of 7.5 g/dL may be considered 2
- For patients undergoing orthopedic surgery or those with preexisting cardiovascular disease, a threshold of 8 g/dL may be considered 2, 3
- For critically ill children and those at risk of critical illness who are hemodynamically stable and without a hemoglobinopathy, cyanotic cardiac condition, or severe hypoxemia, a restrictive transfusion strategy is recommended, considering transfusion when the hemoglobin concentration is less than 7 g/dL 2
- For hemodynamically stable children with congenital heart disease, the transfusion threshold may be based on the cardiac abnormality and stage of surgical repair, ranging from 7 g/dL to 9 g/dL 2
Special Considerations
- For patients with acute coronary syndrome, the optimal transfusion threshold is still uncertain, and further research is needed 4, 5
- For patients with septic shock, a restrictive transfusion strategy may be considered, but the evidence is limited 6
- For patients with chronic transfusion-dependent anemia, the transfusion threshold may vary depending on the underlying condition and individual patient factors 3
Evidence Summary
The evidence suggests that a restrictive transfusion strategy is safe and effective for most patient populations, but the optimal transfusion threshold may vary depending on the individual patient's clinical context and underlying conditions 2, 3, 4, 6, 5