HealthDay News — In a clinical practice guideline published online Octocber 12 in the Journal of the American Medical Association, recommendations are presented for the target hemoglobin level for red blood cell (RBC) transfusion and optimal duration of RBC storage.

Jeffrey L. Carson, MD, from Rutgers University in New Brunswick, NJ, and colleagues developed recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable, as well as optimal storage time for RBCs prior to transfusion. Data were reviewed from randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (31 RCTs with 12,587 participants) and RBC storage duration (13 RCTs with 5,515 participants). 

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The researchers note that when making transfusion decisions regarding an individual patient, the hemoglobin level, overall clinical context, patient preferences, and alternative therapies should be considered. For hospitalized adults who are hemodynamically stable, including critically ill patients, a restrictive RBC transfusion threshold in which transfusion is not indicated until the hemoglobin level is 7 g/dL is recommended. For patients undergoing orthopedic and cardiac surgery and those with preexisting cardiac disease, a restrictive RBC transfusion threshold of 8 g/dL is recommended. Patients should receive RBC units selected at any point within their licensed dating period (storage length: <10 days).

“A restrictive transfusion threshold is safe in most clinical settings and the current blood banking practices of using standard-issue blood should be continued,” the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical technology industries.

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