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Updated: Apr 23, 2026
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Lower versus higher hemoglobin threshold for transfusion in septic shock
Lars B Holst1, Nicolai Haase, Jørn Wetterslev
1From the Department of Intensive Care (L.B.H., N.H., L.H.A., U.G.P., N.R., J. Wiis, J.O.W., L.R., K.J.T., P.B.H., R.G.M., M.H.M., M.S., A.P.), Copenhagen Trial Unit, Center for Clinical Intervention Research (J. Wetterslev, P.W.), and Section for Transfusion Medicine (P.I.J.), Rigshospitalet and University of Copenhagen, Copenhagen, Randers Hospital, Randers (M.L.V., H.B., M.A.T.), Herning Hospital, Herning (R.W., D.L., R.M.), Hvidovre Hospital, Hvidovre (L.N., C.A.), Aarhus University Hospital, Aarhus (H.L.N., D.I.), Aalborg University Hospital, Aalborg (B.S.R.), Holbæk Hospital, Holbæk (J.R.M.L.), Kolding Hospital, Kolding (J.S.N.), and Hjørring Hospital, Hjørring (M.K.) - all in Denmark; Karolinska University Hospital, Huddinge, Stockholm (J. Wernerman, I.T., K.K., S.O.-W.), Karolinska University Hospital, Solna (A.O.), and Södersjukhuset, Stockholm (M.B.C.) - all in Sweden; Haukeland University Hospital and University of Bergen, Bergen, Norway (A.B.G., B.S.); Tampere University Hospital, Tampere (S.K.), and Helsinki University Hospital and University of Helsinki, Helsinki (V.P.) - all in Finland; and Liverpool Hospital, Sydney (A.Å.).
For patients with septic shock, a lower hemoglobin threshold for blood transfusion did not increase 90-day mortality compared to a higher threshold. This approach reduced transfusions without impacting patient outcomes.
Area of Science:
- Critical Care Medicine
- Hematology
- Clinical Trials
Background:
- Blood transfusions are common in septic shock management.
- Optimal hemoglobin thresholds for transfusion in this population remain unclear.
Purpose of the Study:
- To compare the clinical outcomes of restrictive versus liberal hemoglobin thresholds for red blood cell transfusion in patients with septic shock.
Main Methods:
- A multicenter, parallel-group randomized trial.
- Patients with septic shock and hemoglobin ≤9 g/dL were assigned to transfusion thresholds of ≤7 g/dL (lower) or ≤9 g/dL (higher).
- Primary outcome was 90-day mortality.
Main Results:
- 998 patients were randomized.
- The lower-threshold group received fewer transfusions (median 1 unit vs. 4 units).
- 90-day mortality was similar: 43.0% in the lower-threshold group vs. 45.0% in the higher-threshold group (RR 0.94; 95% CI 0.78-1.09).
- Ischemic events and need for life support were also similar between groups.
Conclusions:
- In patients with septic shock, a restrictive hemoglobin transfusion threshold (≤7 g/dL) is as safe as a liberal threshold (≤9 g/dL) regarding 90-day mortality and ischemic events.
- A restrictive strategy significantly reduces the number of red blood cell transfusions administered.
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