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Transfusion strategies in hematologic and nonhematologic disease
Jeffrey L Carson1, Roger Strair2
1Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, and.
Hematology. American Society of Hematology. Education Program
|February 20, 2015
Summary
Red blood cell (RBC) transfusion guidelines suggest a restrictive strategy (lower thresholds) is safe and often better than liberal transfusion. However, specific patient groups, like those with heart attack or stroke, require further research.
Area of Science:
- Transfusion Medicine
- Clinical Trials
- Patient Outcomes
Background:
- Large clinical trials have advanced understanding of red blood cell (RBC) transfusion risks and benefits.
- Over 7000 patients have participated in trials comparing transfusion thresholds.
Purpose of the Study:
- To evaluate the safety and efficacy of restrictive versus liberal RBC transfusion strategies.
- To identify patient populations where further research on transfusion thresholds is warranted.
Main Methods:
- Randomized controlled trials comparing higher (liberal, ~9-10 g/dL) and lower (restrictive, ~7-8 g/dL) RBC transfusion thresholds.
- Enrollment of over 7000 patients across multiple studies.
Main Results:
- Most trials indicate that a restrictive transfusion strategy is safe.
- Restrictive transfusion was found to be superior to liberal transfusion in several cases.
- Preliminary evidence suggests liberal transfusion may benefit patients with myocardial infarction, brain injury, stroke, or hematological disorders.
Conclusions:
- A restrictive RBC transfusion strategy is generally safe and effective.
- Further large trials are necessary for specific conditions like myocardial infarction, stroke, and hematological disorders to determine optimal transfusion thresholds.
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