[Monitoring of allogenic red blood cell transfusions]

Careful assessment of risks and benefits has to precede each decision on allogenic red blood cell (RBC) transfusion. Physicians work to establish more appropriate transfusions of blood components according to the guidelines issued by the Ministry of Health, Welfare, and Labor in Japan. For many years the so-called "10/ 30 rule" was used as a hemoglobin/hematocrit transfusion trigger. However, this rule does not take into account the individual anemia tolerance of a patient nor its individual compensatory mechanisms. RBC transfusions should not be dictated by a single hemoglobin transfusion trigger, but instead should be on the patient's risk of developing complications of inadequate oxygenation. Therefore, transfusion decisions should be primarily based on an individual patient's need for global and regional oxygen supply as indicated by signs of inadequate global and regional oxygenation. However, a hemoglobin transfusion trigger may be useful if matched with some other makers of inadequate tissue perfusion. Therefore, RBC transfusion is recommended under the following circumstances: for hemoglobin levels < 6 g x dl(-1) and for physiologic signs of inadequate oxygenation.