Blood transfusion: one unit too much or one unit too few – which strategy poses the smallest risk to the patient?. (26th September 2017)

• Record Type: Journal Article
• Authors: Seifried, E.; Mueller, M. M.
• Is Part Of: ISBT science series. Volume 13:Number 1(2018)
• Page Start: 101
• Page End: 104
• Publication Date: 2017-09-26
• Subjects: blood transfusion -- haemoglobin measurement -- preoperative treatment of anaemia -- transfusion triggers; Blood -- Periodicals; Blood -- Transfusion -- Periodicals; Immunohematology -- Periodicals; Immunopathology -- Periodicals; 615.39
• DOI: 10.1111/voxs.12366
• Languages: English
• ISSNs: 1751-2816

Abstract

Abstract : The last decades saw numerous prospective clinical trials using different haemoglobin levels as transfusion triggers for packed red blood cell transfusion. In most studies, a restrictive strategy with a lower haemoglobin value as transfusion trigger and a lower haemoglobin target range was compared to a more liberal strategy with higher patient haemoglobin values already triggering transfusion. While such studies answered some important clinical questions in well‐defined study patient populations, many more questions in this field are still open. Studies in patients suffering from acute or chronic neurological disorders, whether traumatic or not, trials in haematological or gynaecological patients are still very scarce or were performed in extremely small cohorts. In addition, the haemoglobin measurement in daily clinical routine suffers from methodological, technical and operational shortcomings. This might impair clinical decisions regarding transfusion triggers. Preoperative anaemia poses a risk for the perioperative outcome of the patient. Thus, it is worthwhile to explore a potential causal relationship between the extent of preoperative anaemia and perioperative mortality. From the existing retrospective trial data comparing preoperative anaemia and perioperative outcome, no such decision can be taken. The best transfusion strategy and the optimal dosing for packed red blood cells are still missing in most indications. Sufficiently powered, prospective, randomized, controlled clinical transfusion trials for packed red blood cells in most clinical settings are urgently needed to reduce ill‐founded clinical decisions and to base transfusion strategies on clinical evidence and scientific study results.