Bethesda, Md. – AABB’s updated recommendations to assist clinicians in making the best possible decisions regarding red blood cell (RBC) transfusion, “Red Blood Cell Transfusion: 2016 Clinical Practice Guidelines from the AABB,” are being published online by The Journal of the American Medical Association (JAMA), an international peer-reviewed medical journal, on October 12.
“The original AABB RBC transfusion guidelines were released in 2012. Since then, several new studies have provided valuable data enabling us to update these evidence-based recommendations to address both RBC transfusion thresholds for broader patient populations and RBC storage duration,” said Miriam A. Markowitz, AABB CEO. “These new recommendations reflect AABB’s commitment to advancing high-quality care for patients.”
The updated guidelines include two main recommendations. AABB recommends a restrictive RBC transfusion threshold of 7 g/dL in hospitalized hemodynamically stable adult patients, including critical care patients, rather than 10 g/dL. For patients undergoing orthopedic surgery, cardiac surgery and those with pre-existing cardiovascular disease, AABB recommends a restrictive RBC transfusion threshold of 8 g/dL. These recommendations are rooted in the premise that, if there is no substantial benefit associated with the transfusion, it is best not to expose the patient to rare but potentially serious risks associated with RBC transfusion. Accordingly, when the evidence suggested that no harms were associated with withholding transfusions, the panel was prepared to make a strong recommendation for the restrictive threshold.
Dr. Jeffrey Carson, the guidelines’ lead author, noted that “[w]hile the recommended threshold of 7 g/dL is consistent with previous AABB guidelines published in 2012, the strength of the recommendation reflects that the number of patients included in trials evaluating transfusion thresholds has doubled to over 12,000 patients since 2012. In addition, we can also make clearer statements about patient cohorts that are excluded from the recommendations.”
“One of the biggest controversies regarding transfusions is whether older blood is harmful,” said Dr. Aaron Tobian, another author of the guidelines, and Chair of AABB’s Clinical Transfusion Medicine Committee. He also noted “there have been 13 randomized trials of more than 5,000 patients that have evaluated the impact of fresher compared to older blood. However, no previous guidelines have made any recommendations on the red blood cell storage duration.”
AABB recommends that patients, including neonates requiring transfusions, receive standard issue rather than fresh RBC units (defined as units that have been stored for less than 10 days). Randomized trials showed that patients who receive standard issue RBCs faced no higher risk for adverse events, and actually encountered a lower risk, than patients transfused with fresher RBCs. Dr. Tobian also said “if data suggest no harm from the use of standard issue blood and fresher blood would only constrain a limited resource, continuing with standard practice is appropriate.”
The newly published guidelines were developed by members of the AABB’s Clinical Transfusion Medicine Committee and consultants from other medical societies, including:
- Jeffrey L. Carson, MD, Rutgers Robert Wood Johnson Medical School
- Gordon Guyatt, MD, McMaster University
- Nancy Heddle, Msc, McMaster University
- Brenda J. Grossman, MD, MPH, Washington University School of Medicine
- Claudia S. Cohn, MD, PhD, University of Minnesota Medical School
- Mark K. Fung, MD, PhD, University of Vermont Medical Center
- Terry Gernsheimer, MD, University of Washington; American Society of Hematology
- John B. Holcomb, MD, University of Texas Medical School; American Association for the Surgery of Trauma
- Lewis J. Kaplan, MD, FACS FCCM, University of Pennsylvania; Society of Critical Care Medicine
- Louis M. Katz, MD, America’s Blood Centers
- Nikki Peterson
- Glenn Ramsey, MD, Feinberg School of Medicine, Northwestern University
- Sunil V. Rao, MD, FACC, Duke University Medical Center; American College of Cardiology
- John D. Roback, MD, PhD, Emory University School of Medicine
- Aryeh Shander, MD, FCCM, FCCP, Englewood Hospital and Medical Center; American Society of Anesthesiologists
- Aaron A. R. Tobian, MD, PhD, Johns Hopkins University School of Medicine; AABB Clinical Transfusion Medicine Committee, Chair
AABB is recognized for setting standards for the collection, processing, and transfusion or clinical administration of blood, blood components, and cellular therapy products. The new RBC guidelines are available at www.aabb.org/programs/clinical/.
AABB is an international, not-for-profit association representing individuals and institutions involved in the fields of transfusion medicine and cellular therapies. The association is committed to improving health through the development and delivery of standards, accreditation and educational programs that focus on optimizing patient and donor care and safety. AABB membership includes physicians, nurses, scientists, researchers, administrators, medical technologists and other health care providers. AABB members are located in more than 80 countries and AABB accredits institutions in over 50 countries.