Red Blood Cell Transfusion in the Emergency Department.
BACKGROUND
Transfusion of red blood cells (RBCs) is the primary management of anemia, which affects 90% of critically ill patients. Anemia has been associated with a poor prognosis in various settings, including critical illness. Recent literature has shown a hemoglobin transfusion threshold of 7 g/dL to be safe. This review examines several aspects of transfusion.


OBJECTIVE
We sought to provide emergency physicians with an updated review of indications for RBC transfusion in the emergency department.


CONCLUSIONS
The standard hemoglobin transfusion threshold was 10 g/dL. However, the body shows physiologic compensatory adaptations to chronic anemia. Transfusion reactions and infections are rare but can have significant morbidity and mortality. Products stored for <21 days have the lowest risk of reaction and infection. A restrictive threshold of 7 g/dL is recommended in the new American Association of Blood Banks guidelines and multiple meta-analyses and supported in gastrointestinal bleeding, sepsis, critical illness, and trauma. Patients with active ischemia in acute coronary syndrome and neurologic injury require additional study. The physician must consider the patient's hemodynamic status, comorbidities, risks and benefits of transfusion, and clinical setting in determining the need for transfusion.


CONCLUSIONS
RBC transfusion is not without risks, including transfusion reaction, infection, and potentially increased mortality. The age of transfusion products likely has no effect on products before 21 days of storage. A hemoglobin level of 7 g/dL is safe in the setting of critical illness, sepsis, gastrointestinal bleeding, and trauma. The clinician must evaluate and transfuse based on the clinical setting and patient hemodynamic status rather than using a specific threshold.
Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.
Brit
B
Long
Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
Alex
A
Koyfman
D000740:Anemia / Q000628:therapy*; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D003657:Decision Making; D004636:Emergency Service, Hospital; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D006454:Hemoglobins / Q000032:analysis; D006801:Humans
D006454:Hemoglobins
RBC; blood product; indications; product age; transfusion; transfusion reaction