We at Centegra in an ongoing effort to provide our patients with the current best practices are adopting the red blood cell transfusion guidelines 1 as recently published by the American association of blood banks (AABB).
These guidelines have been reviewed at Centegra by a committee of physicians, representing hematology, blood bank and anesthesia along with nursing leadership. A comprehensive mandatory nursing education plan is being rolled out along with this initiative.
These guidelines exclude ER and OR
- Recommendation 1: The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence).
- Recommendation 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence).
- Recommendation 3: The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence).
- Recommendation 4: The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence).
Benefits of restrictive red blood cell transfusion
- Blood is a precious resource and must therefore be used responsibly
- Excess transfusion leads to viscosity issues especially in microcirculation where it can paradoxically reduce oxygen delivery 2 3
- Can lead to acute lung injury in critically ill patients (TRALI) 4
- Excess transfusion can lead to excess antigen exposure (antigen priming) 5. Blood transfusion is after all a human tissue transplant.
- Though the blood bank system is safe there is a finite risk of transmissible infection 6
What are the take home points from these guidelines?
- 7 is the new 10 – most patients do not need transfusion till hemoglobin is below 7gm %. Surgical or those with cardiovascular conditions 8gm% is the cutoff
- 1 is the new 2 – transfuse one unit and reassess clinically before ordering the second unit
- Use clinical judgement looking for clinical signs of decompensation rather than just hematocrit
- Use the BMC Transfusion Order REVISED 03.28.13 to guide you
- Call Blood Bank for further questions CHW 815-334-9373 CHM 815-759-4565 or Dr Kyle Annen, Associate Medical Director of Heartland Blood Centers 630-723-2017 or at Kannen@heartlandbc.org
Fact: The first blood bank in the US was established at Cook County Hospital, Chicago Illinois in 1937 at the Fantus clinic by Bernard Fantus. He also coined the term “Blood Bank”.
- Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB ↩
- Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients ↩
- A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. ↩
- Transfusion related lung injury ↩
- Blood transfusion and the immune system ↩
- Blood Management a Clinical Primer ↩