More than 100 million units of blood are collected worldwide each year, yet clinical indications for red blood cell transfusion, and the optimal amount of length to store donated blood, have not been widely-examined. A new article published in the Journal of the American Medical Association provides direction on updating red blood cell transfusion guidelines issued by the American Association of Blood Banks (AABB).
The authors, including Glenn Ramsey, MD, professor of Pathology, recommend a restrictive transfusion policy on the target hemoglobin level for red blood cell transfusion in clinically stable anemic hospitalized adult patients.
The article, which reviewed published evidence on hemoglobin thresholds for transfusion, and red blood cell storage duration, analyzed the results of 31 clinical trials involving more than 12,500 patients who were randomized to either receive a restrictive transfusion strategy (7 g/dl) or liberal transfusion strategy (10 g/dl). The scientists found that adverse consequences were no more common among patients with a restrictive transfusion strategy when compared to liberal transfusion strategy. In patients undergoing orthopedic surgery, cardiac surgery or with preexisting cardiovascular disease, the restrictive transfusion strategy threshold was 8 g/dl.
The investigators also studied the length of time red blood cells should be stored prior to transfusion. They discovered no clinical differences among patients who received longer-storage red blood cells compared to shorter-storage red blood cells, and, as a consequence, the authors recommended blood banks give patients the oldest red blood cells first to minimize wastage.
The guideline development was supported by the AABB.
The Northwestern Memorial Hospital guidelines for blood transfusion, issued by the Transfusion Committee chaired by S. Chris Malaisrie, MD, associate professor of Surgery in the Division of Cardiac Surgery, are in line with the new guidelines, said Ramsey.
“In the past five years, the hospital’s RBC usage has declined by 33 percent,” Ramsey said. “To seek further improvement, in 2017 Northwestern Memorial Hospital blood bank will be implementing a new program to analyze physician transfusion practices and benchmark with other comparable medical centers.”
