From the Guidelines
You should give a unit of blood for a hemoglobin of less than 80 g/dL only if the patient is symptomatic or has a hemoglobin level of 7 g/dL or less, as recommended by the most recent and highest quality study 1. The decision to transfuse blood should be based on symptoms as well as hemoglobin concentration, rather than relying solely on hemoglobin levels 1. Some studies suggest that a restrictive transfusion strategy (7 to 8 g/dL) is recommended in hospitalized, stable patients 1, while others recommend transfusion only when hemoglobin concentration decreases to < 7.0 g/dL in adults in the absence of extenuating circumstances 1. Key considerations include:
- The patient's symptoms and overall clinical condition
- The presence of underlying cardiovascular disease or other comorbidities
- The risk of bleeding or other complications
- The potential benefits and harms of transfusion, including the risk of transfusion-related adverse events. In general, transfusion decisions should be individualized and based on a careful assessment of the patient's needs and risks, rather than relying solely on a specific hemoglobin threshold 1.
From the Research
Transfusion Thresholds
- The decision to transfuse blood depends on various factors, including the patient's symptoms, preferences, and hemoglobin concentration 2.
- A restrictive transfusion strategy with a hemoglobin threshold of 7 to 8 g/dL is considered as safe as a liberal strategy with a threshold of 9 to 10 g/dL in many clinical settings 2.
- However, the optimal transfusion threshold may vary depending on the patient's condition, such as coronary artery disease, congestive heart failure, or myelodysplastic neoplasms 2.
Hemoglobin Levels and Transfusion
- A hemoglobin level of less than 80 g/L may not necessarily require a blood transfusion, as a study found that a transfusion threshold of 80 g/L was comparable to 100 g/L in terms of bleeding in cardiac surgery 3.
- Another study found that hemoglobin levels less than 10 g/dL were common in septic patients, but blood transfusion was not an independent predictor of mortality 4.
- The use of erythropoiesis-stimulating agents (ESAs) as replacement therapy for blood transfusions in critically ill patients with anemia may reduce the need for red blood cell transfusions, but the clinical relevance is questionable 5.
Patient-Specific Factors
- Patient symptoms and preferences should be taken into account when deciding on a transfusion strategy 2.
- The etiology of anemia should be evaluated and managed accordingly, including the use of iron therapy for absolute iron deficiency anemia 2.
- The administration of iron supplementation with or without ESAs may reduce red blood cell utilization in patients with preoperative anemia undergoing elective surgery 6.