The level at which red blood cells are transfused, a common treatment in clinical practice, is often deliberated among physicians. Guidelines for blood transfusion levels were only recently issued in March 2012 diminishing some of the debate. Today, in a new section called JAMA Clinical Evidence Synopsis, the Journal of the American Medical Association (JAMA), published a summary of the systematic review of the 19 clinical trials that compare higher versus lower hemoglobin thresholds in red blood cell transfusion. The comprehensive review concludes that there is no significant difference in patient outcomes with red blood cell transfusions using lower threshold levels.
"Our systematic review of these clinical trials resolves that the use of a restrictive approach to blood transfusions is safe for most patients," said Jeffrey L. Carson, MD, the Richard C. Reynolds Professor of Medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School and lead author of the JAMA manuscript. "The evidence provided in the synopsis can be used to treat anemic patients in both critical and acute care settings without concern of causing undue harm."
More than 6,000 patients with a mean age of 63 years old were part of the 19 studies included in the systematic review, which showed that death did not increase in patients given a lower threshold blood transfusion. Nor was there a significant difference in major complications such as pneumonia, stroke, infection or pulmonary edema.
"Outcomes Using Lower vs. Higher Hemoglobin Thresholds for Red Blood Cell Transfusion" is the inaugural article in JAMA's Clinical Evidence Synopsis section, which will include summaries of large-scale systematic reviews of similar studies. The briefs provide physicians with access to evidence-based information that can be quickly used to improve patient care.
Dr. Carson developed the blood transfusion guidelines along with specialists in cardiology, pediatrics, critical care medicine, trauma and anesthesia that were issued last March by the AABB (formerly the American Association of Blood Banks). He was lead author on two of the clinical trials included in this Clinical Evidence Synopsis.
- Carson JL, Carless PA, Hιbert PC. Outcomes Using Lower vs Higher Hemoglobin Thresholds for Red Blood Cell Transfusion. JAMA, 2013; 309 (1): 83-84 DOI: 10.1001/jama.2012.50429
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