Provider perceptions of indications for red blood cell transfusion

Guidelines for red blood cell transfusion recommend incorporating patient factors and clinical context beyond hemoglobin (Hb) levels. However, limited data exist on which factors clinicians consider important. Understanding these decision-making elements can clarify how guidelines are applied and inform future research. This study aimed to identify and prioritize factors that influence transfusion decisions among inpatient clinicians.

Inpatient clinicians who are high utilizers of transfusion were administered a survey and asked to rate the importance of 30 decision-making factors using a 3-point Likert scale (very, somewhat, not important). Additional questions addressed transfusion practices and anemia management using a 5-point Likert scale (very much disagree to very much agree). Descriptive statistics were used to characterize study participants and survey responses, and regression models explored associations between responses and participant characteristics.

Of 95 eligible clinicians, 85 (89%) completed the survey. Only 7 of the 30 factors were rated as "very important" by more than 66% of respondents; 5 of these were Hb-related. Importance assigned to other non-Hb-related factors varied. Most clinicians (85%) do believe that anemia can result in significant adverse consequences. Most clinicians further believe that restrictive transfusion is standard of care (88%) and optimal (68%), but also that transfusion decisions need to incorporate factors other than a patient's Hb level (84%) at the same time.

Despite guidelines suggestions, there is a lack of consensus on what clinical factors beyond Hb clinicians believe are important in making transfusion decisions.