From the Guidelines
The transfusion threshold of 8 g/dL is recommended for patients with stable, non-cardiac conditions, such as those with chronic anemia or undergoing minor surgical procedures [ 1 ].
Key Considerations
- In these cases, a hemoglobin level below 8 g/dL is considered an indication for red blood cell transfusion, with a target post-transfusion hemoglobin level of 9-10 g/dL [ 1 ].
- For patients with cardiac disease or those undergoing major surgery, a more liberal transfusion threshold of 9-10 g/dL may be considered, with the goal of optimizing oxygen delivery to tissues [ 1 ].
- The AABB suggests adhering to a restrictive transfusion 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 [ 1 ].
- Transfusion decisions should be influenced by symptoms as well as hemoglobin concentration [ 1 ].
Important Factors
- The presence of cardiovascular disease, such as coronary artery disease, may require a more liberal transfusion threshold [ 1 ].
- Symptoms such as chest pain, orthostatic hypotension, or tachycardia unresponsive to fluid resuscitation, or congestive heart failure, should also be considered when deciding to transfuse [ 1 ].
From the Research
Transfusion Threshold of 8 g/dL of Hemoglobin
- The use of a transfusion threshold of 8 g/dL of hemoglobin is recommended for specific patient populations, such as those undergoing orthopedic surgery or those with preexisting cardiovascular disease 2.
- This threshold is based on the restrictive strategy used in most trials, which has been shown to be safe and effective for most patient populations 2.
- However, the decision to transfuse should be individualized and based on the patient's overall clinical context and alternative therapies to transfusion 2.
- A study on perioperative red blood cell transfusion and outcome in stable patients after elective major vascular surgery found that transfusion was associated with a significantly increased risk of 30-day events, particularly in patients without anaemia 3.
- Another study on individualized red-cell transfusion strategy for non-cardiac surgery in adults found that an individualized strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 compared to restrictive and liberal strategies 4.
- A study on hospital discharge hemoglobin values and posthospitalization clinical outcomes in transfused patients undergoing noncardiac surgery found that severe anemia (hemoglobin < 8 g/dL) was associated with increased readmission rates and posthospitalization RBC transfusion rates 5.
- The choice of transfusion threshold may vary depending on the patient's medical status, surgical procedure, and institutional protocols, highlighting the need for careful consideration of individual patient factors and evidence-based guidelines 6.