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Blood transfusion is a therapeutic measure to restore the blood volume after extensive blood loss due to an accident or a medical procedure. Blood transfusion involves drawing a certain amount of blood from a suitable donor and infusing it into the recipient.
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The ABO blood group system is a critical element of transfusion medicine, essential for determining blood compatibility in transfusions and organ transplants. It is based on specific antigens, or agglutinogens, present on the surface of red blood cells (RBCs) and corresponding antibodies, or agglutinins, in the blood plasma.
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Understanding an individual's blood group is a critical component of transfusion medicine. It ensures compatibility in blood transfusions, organ transplants, and even during pregnancy. Determining these blood groups involves the ABO and Rh blood typing systems, utilizing specific antigens and corresponding anti-sera to identify an individual's blood type.
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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
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Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage.

Jeffrey L Carson1, Gordon Guyatt2, Nancy M Heddle3

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Restrictive red blood cell (RBC) transfusion thresholds are safe for most hospitalized adults. Standard-issue RBC units, regardless of storage duration, are recommended over fresh units for transfusion.

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Area of Science:

  • Transfusion Medicine
  • Hematology
  • Clinical Guidelines

Background:

  • Over 100 million units of red blood cells (RBCs) are collected globally each year.
  • Uncertainty exists regarding optimal hemoglobin thresholds for RBC transfusion and storage duration.

Purpose of the Study:

  • To recommend target hemoglobin levels for RBC transfusion in stable hospitalized adults.
  • To determine the optimal storage duration for RBCs before transfusion.

Main Methods:

  • Systematic literature search of randomized clinical trials (RCTs) from 1948-2016.
  • Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology used for evidence summary.
  • Analysis of 31 RCTs for transfusion thresholds and 13 RCTs for storage duration.

Main Results:

  • Restrictive RBC transfusion thresholds (7-8 g/dL hemoglobin) were not associated with increased adverse clinical outcomes compared to liberal thresholds (9-10 g/dL).
  • No significant difference in clinical outcomes was observed between fresher RBC units (<10 days storage) and standard-issue RBC units.
  • Recommendations apply to stable hospitalized adults, excluding acute coronary syndrome, severe thrombocytopenia, and chronic transfusion-dependent anemia.

Conclusions:

  • Restrictive red blood cell transfusion thresholds are safe and effective for most hemodynamically stable hospitalized adult patients.
  • Current blood banking practices of using standard-issue blood (any point within licensed dating period) should continue.
  • Evidence supports updated guidelines for red blood cell transfusion practices.