title: Red blood cell transfusion: a clinical practice guideline from the AABB*.
abstract: METHODS
  Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children.
  
  
  METHODS
  These guidelines are based on a systematic review of randomized clinical trials evaluating transfusion thresholds. We performed a literature search from 1950 to February 2011 with no language restrictions. We examined the proportion of patients who received any RBC transfusion and the number of RBC units transfused to describe the effect of restrictive transfusion strategies on RBC use. To determine the clinical consequences of restrictive transfusion strategies, we examined overall mortality, nonfatal myocardial infarction, cardiac events, pulmonary edema, stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay. 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).
authors: MD, Division of General Internal Medicine, UMDNJ–Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08903, USA. carson@umdnj.edu
authors: Jeffrey L
authors: JL
authors: Carson
authors: Brenda J
authors: BJ
authors: Grossman
authors: Steven
authors: S
authors: Kleinman
authors: Alan T
authors: AT
authors: Tinmouth
authors: Marisa B
authors: MB
authors: Marques
authors: Mark K
authors: MK
authors: Fung
authors: John B
authors: JB
authors: Holcomb
authors: Orieji
authors: O
authors: Illoh
authors: Lewis J
authors: LJ
authors: Kaplan
authors: Louis M
authors: LM
authors: Katz
authors: Sunil V
authors: SV
authors: Rao
authors: John D
authors: JD
authors: Roback
authors: Aryeh
authors: A
authors: Shander
authors: Aaron A R
authors: AA
authors: Tobian
authors: Robert
authors: R
authors: Weinstein
authors: Lisa Grace
authors: LG
authors: Swinton McLaughlin
authors: Benjamin
authors: B
authors: Djulbegovic
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood; D000328:Adult; D001771:Blood Banks / Q000592:standards; D002648:Child; D003661:Decision Support Techniques; D017707:Erythrocyte Transfusion / Q000592:standards*; D019983:Guideline Adherence; D006441:Hemoglobin A / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014481:United States
chemical_list: D006441:Hemoglobin A