title: Concepts of blood transfusion in adults.
abstract: Recent progress has been made in the identification and implementation of best transfusion practices on the basis of evidence-based clinical trials, published clinical practice guidelines, and process improvements for blood use and clinical patient outcomes. However, substantial variability persists in transfusion outcomes for patients in some clinical settings--eg, patients undergoing cardiothoracic surgery. This variability could be the result of insufficient understanding of published guidelines; different recommendations of medical societies, including the specification of a haemoglobin concentration threshold to use as a transfusion trigger; the value of haemoglobin as a surrogate indicator for transfusion benefit, even though only changes in concentration and not absolute red cell mass of haemoglobin can be identified; and disagreement about the validity of the level 1 evidence for clinical practice guidelines. Nevertheless, institutional experience and national databases suggest that a restrictive blood transfusion approach is being increasingly implemented as best practice.
authors.affiliation: Department of Pathology, Stanford University, Stanford, CA, USA. ltgoodno@stanford.edu
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: Jerrold H
authors.initials: JH
authors.lastname: Levy
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000150:complications; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000592:standards; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D065227:Transfusion Reaction
chemical_list: D006454:Hemoglobins