Transfusion triggers: A systematic review of the literature*

Fatores preditivos da transfusão de concentrado de hemácias em pacientes submetidos a cirurgias eletivas do aparelho digestivo: uma análise interinstitucional

“…A large variability in transfusion protocols between institutions was observed in this study as was the adoption of an old fashioned marker, the 10 g/dL threshold for hemoglobin, by many intensivists. (20,21) These data were corroborated by another study carried out by the same group, that show the high inter-and intra-institutional variability of blood transfusions in patients undergoing coronary artery bypass surgery. (5) Other interinstitutional studies conducted by European groups have also shown great variability in the transfusion practice in patients undergoing orthopedic and other types of surgeries.…”

“…Hematologic values that serve as the "transfusion trigger" are not consensual and the use of RBCT is remarkably variable. (2)(3)(4)(5) These data seem to support the plasticity that the human body has to compensate for blood loss and overcome difficulties in oxygen transportation and suggest that lower hemoglobin and hematocrit levels than those used in transfusion decision making are perfectly acceptable without using RBCT. (6,7) In addition, the use of alternative transfusion procedures in the pre-and intraoperative periods including red cell recovery, hemodilution with crystalloids, an increased oxygen supply, use of erythropoietin, iron and vitamin B12 supplements, has reduced the effect of blood loss and does not result in changes related to hypoxia, hypotension or arrhythmia.…”

Blood Tranfusion in Critically Ill Patients: State of the Art

“…There was insufficient data on potentially relevant clinical outcomes such as stroke, thromboembolism, multiorgan failure, delirium, infection or delayed wound healing to perform any pooled analysis. Carson and colleagues 49 stated there were insufficient data to address the full range of risks and benefits associated with different transfusion thresholds, particularly in patients with coexisting disease. They also noted that their meta-analysis was dominated by a single trial: the TRICC trial, 8 which enrolled 838 patients and was the only individual trial identified that was adequately powered to evaluate the impact of different transfusion strategies on mortality and morbidity.…”

“…Carson et al 49 were able to identify only 10 randomized clinical trials of adequate methodological quality in which different RBC transfusion triggers were evaluated. Included were a total of 1780 surgery, trauma, and ICU patients enrolled in trials conducted over the past 40 years.…”

Is there a “magic” hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices

“…A systematic review prior to 2000 had identified ten trials [19]. This review concluded that existing evidence at that time supported the use of restrictive transfusion triggers in patients who were free of serious cardiac disease.…”