When is red blood cell transfusion indicated?

Updated: Apr 16, 2019
  • Author: Linda L Maerz, MD, FACS, FCCM; Chief Editor: Emmanuel C Besa, MD  more...
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Allogeneic transfusion of whole blood and fractionated blood components remains a controversial topic with respect to transfusion triggers and practices.  Any licensed independent practitioner can order a blood transfusion and obtain consent to do so. Attribution of the decision to transfuse is nearly impossible to track, especially in the perioperative period, intraoperatively, or in the trauma bay, because the individual who makes the decision to transfuse is likely not the person who is entering the orders in those circumstances. In spite of widespread use, data supporting specific practice paradigms for whole blood and component therapy transfusion are lacking, the notable exception being in the primary treatment of hemorrhagic shock. In general, there is little evidence to suggest that increasing hemoglobin concentration, arteriolar oxygen content, or global oxygen delivery results in improved oxygen utilization. Opinions are embraced and defended, but transfusion of red blood cells has not reliably demonstrated increased survival, other than in 2 specific populations, as follows: (1) those with active hemorrhage, and (2) those with active cardiac ischemia.

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