Bethesda, Md. – More than 15 million units of whole blood and red cells are transfused annually in the United States, and the decision on when to transfuse a patient varies widely among medical practitioners. To optimize patient blood management, AABB (formerly the American Association of Blood Banks) developed a clinical practice guideline with recommendations for the appropriate use of red cell transfusions for stable adults and children, which was published today in the Annals of Internal Medicine.
"In order to avoid unnecessary transfusions, AABB developed this guideline to provide clinicians with evidence-based recommendations about when it is appropriate to transfuse," said Jeffrey L. Carson, MD, chief of the Division of General Internal Medicine at UMDNJ-Robert Wood Johnson Medical School in New Brunswick, N.J., and lead author of the guideline. "Optimal patient care should involve administering enough red blood cells to maximize clinical outcomes while avoiding transfusions that expose patients to potential infectious or noninfectious risks and increase medical costs."
In general, the AABB Guideline makes three recommendations:
- Adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients;
- 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; and
- Considering symptoms as well as hemoglobin concentration during transfusion decisions.
The AABB Guideline could not recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with acute coronary syndrome.
The blood supply is as safe as it has ever been, and every day in the U.S. approximately 44,000 units of blood are required to treat patients in need. However, as recognized in 2011 by the U.S. Department of Health and Human Services' Advisory Committee on Blood Safety and Availability, wide variability in the use of transfusions in the U.S. indicates that there is both excessive and inappropriate use of blood.
"AABB believes that hospitals and clinicians can reduce the number of unnecessary transfusions," noted Darrell J. Triulzi, MD, AABB president and medical director of the Institute for Transfusion Medicine in Pittsburgh. "Implementing evidence-based transfusion thresholds is perhaps the most important step hospitals can take to achieve this goal. AABB is committed to advancing overall patient blood management, which encompasses application of appropriate indications, as well as strategies to minimize blood loss and maximize the patient's red cell mass before, during and after hospitalization."
To view a copy of "Red Blood Cell Transfusion: A Clinical Practice Guideline from the AABB," visit: http://www.annals.org/content/early/2012/03/26/0003-4819-156-12-201206190-00429. For additional information regarding patient blood management, visit: www.aabb.org/pbm.
Members of AABB's Clinical Transfusion Medicine Committee, along with representatives from the following major stakeholders in transfusion practice developed the guideline: American Association for the Surgery of Trauma, American College of Cardiology, American Society of Anesthesiologists, American Society of Hematology, and Society for Critical Care Medicine.
AABB is an international, not-for-profit association representing individuals and institutions involved in the field of transfusion medicine and cellular therapies. The association is committed to improving health by developing and delivering standards, accreditation and educational programs that focus on optimizing patient and donor care and safety. AABB membership consists of nearly 2,000 institutions and 8,000 individuals, including physicians, nurses, scientists, researchers, administrators, medical technologists and other health care providers. Members are located in more than 80 countries. For more information, please visit www.aabb.org.