Transfusion Medicine

Meet the patient

A 78-year-old woman sits on the orthopaedic ward three days after a fractured neck of femur. Her haemoglobin is 76 g/L, she has a history of ischaemic heart disease, and the registrar rings at 6pm asking for two units "to get her ready for theatre". That one stem is the whole of transfusion medicine in miniature.^[5]

The question it forces — does this patient need this component, at this threshold, right now — is the question every transfusion decision downstream is a variation on. The evidence base exists to help you answer it, not to hand you a number to chase.^[5]

References19ShowHide

1. [1]Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group N Engl J Med, 1999.PMID 9971864
2. [2]Holst LB, Haase N, Wetterslev J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock N Engl J Med, 2014.PMID 25270275
3. [3]Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery N Engl J Med, 2011.PMID 22168590
4. [4]Carson JL, Brooks MM, Abbott JD, et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia N Engl J Med, 2023.PMID 37952133
5. [5]Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage JAMA, 2016.PMID 27732721
6. [6]Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial JAMA, 2015.PMID 25647203
7. [7]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319
8. [8]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
9. [9]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery N Engl J Med, 2017.PMID 29130845
10. [10]Kleinman S, Caulfield T, Chan P, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel Transfusion, 2004.PMID 15584994
11. [11]Ducrocq G, Gonzalez-Juanatey JR, Puymirat E, et al. Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial JAMA, 2021.PMID 33560322
12. [12]Stanworth SJ, Estcourt LJ, Powter G, et al. A no-prophylaxis platelet-transfusion strategy for hematologic cancers N Engl J Med, 2013.PMID 23656642
13. [13]Kaufman RM, Djulbegovic B, Gernsheimer T, et al. Platelet transfusion: a clinical practice guideline from the AABB Ann Intern Med, 2015.PMID 25383671
14. [14]Davenport R, Curry N, Fox EE, et al. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial JAMA, 2023.PMID 37824155
15. [15]Cappellini MD, Porter JB, El-Beshlawy A, et al. Tailoring iron chelation by iron intake and serum ferritin: the prospective EPIC study of deferasirox in 1744 patients with transfusion-dependent anemias Haematologica, 2010.PMID 19951979
16. [16]Treleaven J, Gennery A, Marsh J, et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force Br J Haematol, 2011.PMID 21083660
17. [17]Roubinian NH, Looney MR, Kor DJ, et al. NT-proBNP levels in the identification and classification of pulmonary transfusion reactions Transfusion, 2020.PMID 32905629
18. [18]Roubinian NH Transfusion-Associated Circulatory Overload and Transfusion-Related Acute Lung Injury: Etiology and Prevention Hematol Oncol Clin North Am, 2019.PMID 31466603
19. [19]Bolton-Maggs PHB Transfusion errors - can they be eliminated? Br J Haematol, 2020.PMID 31792932