Comment: There were insufficient data of the safety of transfusion in certain clinical subgroups, including acute myocardial infarction, neurological injury/traumatic brain injury, stroke, thrombocytopenia, cancer, haematological malignancies, and bone marrow failure
A Cochrane review [Abstract] 1 included 31 studies with a total of 12 587 subjects assessing the optimal haemoglobin threshold for the use of red blood cell (RBC) transfusions in anaemic patients (across a range of clinical specialities e.g. surgery, critical care). The restrictive transfusion threshold used a lower haemoglobin level to trigger transfusion (most commonly 7 g/dL or 8 g/dL), and the liberal transfusion threshold uses a higher haemoglobin level to trigger transfusion (most commonly 9 g/dL to 10 g/dL). Restrictive strategies reduced the risk of receiving a RBC transfusion by 43% across a broad range of clinical specialties (table T1). Overall, restrictive transfusion strategies compared with liberal transfusion strategies did not increase or decrease the risk of 30-day mortality or any of the other outcomes assessed (i.e. cardiac events, myocardial infarction, stroke, thromboembolism, pneumonia, wound, or bacteraemia) (table T1).
Outcome | Relative effect(95% CI) | Assumed risk -Control - Liberal transfusion (Hb 9 g/dL to 10 g/dL) | Corresponding risk - Intervention - Restrictive transfusion (Hb 7 g/dL to 8 g/dL) | No of participants(studies) Quality of evidence |
---|---|---|---|---|
People receiving blood transfusions | RR 0.57 (0.49 to 0.65) | 841 / 1000 | 479 / 1000 | 12 587 (31), High |
30-day mortality | RR 0.97 (0.81 to 1.16) | 93 / 1000 | 90 / 1000 | 10 537 (23), Moderate |
Myocardial infarction | RR 1.08 (0.74 to 1.60) | 17 / 1000 | 19 / 1000 | 8 303 (16), High |
Congestive heart failure | RR 0.78 (0.45 to 1.35) | 36 / 1000 | 28 / 1000 | 6 257 (12), Low |
Cerebrovascular accident - stroke | RR 0.78 (0.53 to 1.14) | 17 / 1000 | 13 / 1000 | 7 343 (13), High |
Rebleeding | RR 0.75 (0.51 to 1.10) | 163 / 1000 | 144 / 1000 | 3 108 (6), Low |
Pneumonia | RR 0.94 (0.80 to 1.11) | 82 / 1000 | 76 / 1000 | 6 277 (14), High |
Thromboembolism | RR 0.77 (0.41 to 1.45) | 10 / 1000 | 8 / 1000 | 4 019 (10), High |
Date of latest search: 27 May 2016
Primary/Secondary Keywords