Blood Transfusion in 2014

Hematology PGY1 PGY2 PGY3 PGY4

I had several discussions in ED regarding blood transfusion in anemic patients. My argument is that if patient does not have any acute symptoms (SOB, feeling faint, tachycardia, Cardiac ischemia, …), there is no need to emergently transfuse patients in ED. Our threshold to transfuse was 10/30 vs 9/28/ vs 8/26 long time ago and there was no definite number to stick to. In 2006, Journal of Trauma published a practice guideline: Guidelines for transfusion in the trauma patient. They recommended a threshold of Hb 7 to transfuse but non-surgeons doctors argued this with their specific patient population that they have. The argument was: trauma patients usually are young without morbidity or significant PMH, but medicine patients usually suffer from diseases and anemia can affect this threshold! When this study published in NEJM: Transfusion strategies for acute upper gastrointestinal bleeding. There was no argument that sick patient with UGIB could benefit from restrictive plan!

Now in JAMA: Health Care–Associated Infection After Red Blood Cell Transfusion A Systematic Review and Meta-analysis there is a systematic review with 18 studies that shows a restrictive plan for transfusion will help to reduce blood borne diseases. Do we still argue this?