RBC Transfusion Thresholds
SUMMARY
For most stable (i.e. not in hemorrhagic shock) patients, consider a hemoglobin transfusion threshold of 70-80.
| Study | Population | Takeaway |
|---|---|---|
| REALITY (2021) | Acute myocardial infarction | restrictive transfusion threshold (hemoglobin ≤8) was non-inferior to a liberal threshold (hemoglobin ≤10) for 30 day MACE events |
| Transfusion Strategies for Acute Upper Gastrointestinal Bleeding (2013) | Acute upper GIB, stable. | restrictive transfusion threshold (Hgb ≥7) was associated with reduced mortality at 45 days compared to a liberal transfusion threshold (Hgb ≥10) |
| TRICS-III (2017) | Cardiac surgery patients | restrictive transfusion (Hb < 75) is noninferior for major clinical outcomes than Hb < 95 for patients undergoing on-pump cardiac surgery |
| TRICC (1999) | Critically ill patients | restrictive transfusion (Hgb >7 g/dL) is associated with better survival compared to liberal strategy (Hgb >10) |
| FOCUS (2011) | High CV-risk patients post hip fracture surgery | No significant MACE difference between restrictive (Hb < 80) and liberal (Hb < 100) transfusion strategies. However, reduction in units of blood (0 vs 2). |
| TITRe2 (2015) | Non-emergency cardiac surgery | restrictive transfusion threshold (Hb < 75) vs liberal (Hb < 90) did not lead to differences in ischemia/infection within 3 months. Restrictive threshold associated with reduced mortality at 90 days (1.9% vs 2.6%, p=0.045) |
| TRISS (2014) | Septic shock | restrictive transfusion threshold (Hb < 70) was associated with similar mortality but 50% reduction in blood transfusion units compared to Hb 90 threshold |