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Numerous randomized control trials compared hemoglobin concentrations to determine the optimal threshold to make transfusion decisions. Most frequently, these studies included patients requiring hip or cardiac surgery and patients admitted to intensive care units. Consistently across studies and clinical settings, restrictive transfusion thresholds have demonstrated similar outcomes compared to liberal thresholds. However, studies defined the restrictive arm using hemoglobin concentrations with ranges from 7 to 8 g/dL, depending on the setting and clinical studies. The question remains whether differences in hemoglobin concentrations (i.e., 7 versus 7.5 versus 8 g/dL) are clinically relevant. The two speakers will debate these two perspectives providing arguments for and against these options. These issues were extensively discussed within an international panel for an updated AABB-sponsored red blood cell guidelines, and the final recommendations will be presented. This session will present the new guidelines, including new recommendations for pediatric patients and patients with hematologic conditions. It will expand on some unanswered questions, such as the definition of a restrictive threshold and traumatic brain injury.
Learning Objectives:
Recognize new evidence evaluating red blood cell transfusion thresholds for transfusion
Evaluate the clinical relevance of using a common restrictive red blood cell transfusion threshold for different clinical scenarios
Apply this information to inform red blood cell transfusion practices
Moderator(s):
Monica
B. Pagano,
MD,
Division Head of Transfusion Medicine, Medical Director Transfusion Services,
University of Washington
Speaker(s):
Jeffrey
Carson,
MD,
Provost and Distinguished Professor of Medicine,
Rutgers Robert Wood Johnson Medical School
Simon
Stanworth,
FRCP FRCPath DPhil,
Professor of Haematology and Transfusion Medicine; Consultant Haematologist,
University Oxford
Disclosures
Jeffrey Carson, MD:
Cerus: Serve as Chair of DSMB for one of their trials (Ongoing)