Intraoperative Red Blood Cell Transfusion Decision-making: A Systematic Review of Guidelines.

Area of Science:

• Transfusion Medicine
• Surgical Critical Care
• Evidence-Based Medicine

Background:

• Red blood cell (RBC) transfusions are frequently administered during surgical procedures.
• Significant variability exists in current intraoperative transfusion practices.

Purpose of the Study:

• To systematically review clinical practice guidelines (CPGs) for intraoperative RBC transfusions.
• To evaluate the indications, decision-making processes, and evidence base supporting these CPGs.

Main Methods:

• A systematic search of major electronic databases and Google Scholar was conducted.
• Ten eligible CPGs published between 1992 and 2018 were identified and assessed for quality using AGREE II.
• Recommendations were abstracted and synthesized for comparative analysis.

Main Results:

• Ten guidelines provided indications for intraoperative RBC transfusion, with six using hemoglobin or hematocrit triggers (6.0-10.0 g/dL or <30%).
• Guidelines often recommended considering blood loss, end-organ ischemia, and hemodynamics in the absence of objective rules.
• Evidence supporting recommendations was largely extrapolated from nonoperative settings, and guideline quality varied significantly.

Conclusions:

• Existing CPGs for intraoperative RBC transfusions exhibit considerable variability in recommendations.
• A notable knowledge gap exists due to the insufficient evidence base derived specifically from the intraoperative setting.
• There is a critical need for developing robust, evidence-based guidelines for intraoperative transfusion practices.